ANMJ June 2016

V O LU M E 2 3 , N O. 1 1 / J U N E 2 0 1 6

2016 FEDERAL ELECTION www.anmf.org.au

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CONTENTS Directory 02

2016 FEDERAL ELECTION

Editorial 03 News 04 News Feature

15

Feature 16 World 23 Industrial

24

Ethics

33

Clinical Update

34

Reflection 37 Issues 38 Research 39 Focus – Mental Health (part 2) 40

16

Calendar 53 Mail 54 Annie 56

04 23 40 anmf.org.au

June 2016 Volume 23, No. 11 1

Canberra

3/28 Eyre Street, Kingston ACT 2604 Phone (02) 6232 6533 Fax (02) 6232 6610 Email anmfcanberra@anmf.org.au

Editorial

Melbourne & ANMJ

Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email anmfmelbourne@anmf.org.au

Federal Secretary Lee Thomas

Assistant Federal Secretary Annie Butler

Editor: Kathryn Anderson Journalist: Natalie Dragon Journalist: Robert Fedele Production Manager: Cathy Fasciale Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email anmj@anmf.org.au

Advertising Freelance Media E: jana@freelancemedia.net.au M: 0477 882 492

Design and production Design: Daniel Cordner Printing: AIW Printing Distribution: D&D Mailing Services

Australian Capital Territory Branch Secretary Jenny Miragaya Office address 2/53 Dundas Court, Phillip ACT 2606 Postal address PO Box 4, Woden ACT 2606 Ph: (02) 6282 9455 Fax: (02) 6282 8447 E: anmfact@anmfact.org.au

Northern Territory

South Australia

Victoria

Branch Secretary Yvonne Falckh

Branch Secretary Elizabeth Dabars

Branch Secretary Lisa Fitzpatrick

Office address 16 Caryota Court, Coconut Grove NT 0810 Postal address PO Box 42533, Casuarina NT 0811 Ph: (08) 8920 0700 Fax: (08) 8985 5930 E: info@anmfnt.org.au

Office address 191 Torrens Road, Ridleyton SA 5008 Postal address PO Box 861 Regency Park BC SA 5942 Ph: (08) 8334 1900 Fax: (08) 8334 1901 E: enquiry@anmfsa.org.au

Office address ANMF House, 540 Elizabeth Street, Melbourne Vic 3000 Postal address PO Box 12600 A’Beckett Street Melbourne Vic 8006 Ph: (03) 9275 9333 Fax (03) 9275 9344 Information hotline 1800 133 353 (toll free) E: records@anmfvic.asn.au

The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia.

Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement.

All rights reserved. Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrang­ement with the Australian Nursing & Midwifery Federation Federal Office Note: ANMJ is indexed in the cumulative index to nursing and allied health literature and the international nursing index ISSN 2202-7114

Moving state? Transfer your ANMF membership

If you are a financial member of the ANMF, QNU or NSWNMA, you can transfer your membership by phoning your union branch.

Don’t take risks with your ANMF membership – transfer to the appropriate branch for total union cover. It is important for members to consider that nurses who do not transfer their membership are probably not covered by professional indemnity insurance.

New South Wales

Queensland

Tasmania

Western Australia

Branch Secretary Brett Holmes

Branch Secretary Beth Mohle

Branch Secretary Neroli Ellis

Branch Secretary Mark Olson

Office address 50 O’Dea Avenue, Waterloo NSW 2017 Ph: 1300 367 962 Fax: (02) 9662 1414 E: gensec@nswnma.asn.au

Office address 106 Victoria Street West End Qld 4101 Postal address GPO Box 1289 Brisbane Qld 4001 Phone (07) 3840 1444 Fax (07) 3844 9387 E: qnu@qnu.org.au

Office address 182 Macquarie Street Hobart Tas 7000 Ph: (03) 6223 6777 Fax: (03) 6224 0229 Direct information 1800 001 241 (toll free) E: enquiries@anmftas.org.au

Office address 260 Pier Street, Perth WA 6000 Postal address PO Box 8240 Perth BC WA 6849 Ph: (08) 6218 9444 Fax: (08) 9218 9455 1800 199 145 (toll free) E: anf@anfwa.asn.au

2 June 2016 Volume 23, No. 11

ANMJ IS PRINTED ON A2 GLOSS FINESSE, PEFC ACCREDITED PAPER. THE JOURNAL IS ALSO WRAPPED IN BIOWRAP, A DEGRADABLE WRAP.

135,863

TOTAL READERSHIP

Based on ANMJ 2014 member survey pass on rate Circulation: 93,185 BCA audit, March 2016

anmf.org.au

EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary Within a few weeks the federal election will be upon us. As Australia decides which political party will lead the country for the next three years, we are calling on politicians to take action to ensure Australia’s quality healthcare system is upheld and accessible to all now and into the future.

The forecast for healthcare, as it stands, seems worryingly bleak to say the least.

Since the Coalition government took power we have seen significant cuts of $57 billion in health funding which are to occur over the next 10 years, an attack on rebates for Medicare and bulk billing, a threat to penalty rates for all workers and the continual erosion of funding and services in aged care, such as appropriate staff mix.

INCORPORATED IN THIS MONTH’S JOURNAL IS ALSO A ROUNDUP OF THE 2016 BUDGET IN RELATION TO HEALTH CUTS AND FOREIGN AID. I URGE YOU TO READ THIS ARTICLE WHICH HELPS PAINT THE PICTURE OF HOW THESE CUTS ARE HURTING US ALL.

The predicted outcomes of these cutbacks are so dire, it has become urgent to fight for the quality healthcare that all Australians so rightly deserve.

Over the past two months the ANMF has lobbied politicians and the public through the If you don’t care, we can’t care campaign, where we are asking our political leaders to stop the attack on healthcare funding, aged care and Medicare. We are also demanding that penalty rates for all workers be maintained.

If you read last month’s ANMJ, visited ANMF’s Facebook page or the website you would have seen the work we have done to get this message through and, as a result, it’s fair to say members, the public and politicians are taking notice.

But we need your help to continue the momentum to ensure our voice is heard loud and clear.

ICareandIVote

Incorporated in this month’s journal is also a roundup of the 2016 Budget in relation to health cuts and foreign aid. I urge you to read this article which helps paint the picture of how these cuts are hurting us all.

On a different note, the ANMJ has featured a number of moving stories on nurses who served for our country during different wars. Notably mentioned are the Southeast Asia Treaty Organisation (SEATO) nurses who volunteered to serve in Vietnam and who, like many Vietnam veterans, experienced the traumas of conflict resulting in physical and mental conditions. However, unlike those who served in the military, the SEATO nurses do not have access to veterans’ entitlements because they are viewed by the government as civilians. The ANMF has supported and lobbied for these nurses and will continue to do so.

As I sign off I would like to commend the ANMF Victorian Branch and its members for their momentous EBA win for public sector nurses and midwives.

The agreement will see nurses and midwives on wage parity with their NSW counterparts in the upcoming years.

Additionally, the agreement includes improved conditions. Further, I am pleased to announce that Queensland has recently legislated nurse to patient ratios that will make it mandatory for public hospitals in that state to maintain minimum staffing levels.

Two great historic wins for the professions.

Congratulations to all.

If you have not done so already, join and actively engage with the campaign’s Facebook page (facebook/ ICareandIVote); write to the politicians voicing your concerns (templates can be found on the campaign website

@AustralianNursingandMidwiferyFederation

anmf.org.au

www.ICareandIVote.com.au), and keep informed through avenues such as reading this month’s feature on the issues that are harming healthcare and educate your peers and the community.

@anmfbetterhands

www.anmf.org.au

June 2016 Volume 23, No. 11 3

NEWS

VICTORIAN NURSES PULL OFF HISTORIC PAY RISE DEAL

Nurses and midwives working across Victoria’s public-sector have secured major pay rises that will lift them on par with their New South Wales colleagues following hard-fought EBA negotiations last month.

A deal was struck in early May, just one day before planned industrial action was set to begin that would have seen rolling strikes and 25% of the state’s hospital beds closed.

Under the agreement, nurses and midwives will receive pay rises between 3.6% and 4.8% this year, followed by 3% in 2017 and 3.25% in 2018.

In 2019, Victorian nurses and midwives will move to a new career grading scheme that will boost their wages and achieve longoverdue parity with their NSW counterparts.

A pledge to lock in 3% yearly increases for the first three years of the next EBA was also reached.

The new agreement includes improved roster conditions with increased handover time allowing for better patient care, increased focus by hospital management on environmentally sustainable programs including waste management in areas such as emergency departments and further measures to reduce the illness and injury of nurses.

4 June 2016 Volume 23, No. 11

The agreement made with the Andrews Labor government marks the first time in 20 years that Victorian nurses and midwives have been able to harmoniously adopt a contract without being forced to take industrial action.

THIS TIME WE WERE ABLE TO FOCUS ON FAIR PAY AND CONDITIONS AND WE HAVE ACHIEVED THAT WITHOUT TAKING SIGNIFICANT INDUSTRIAL ACTION FOR THE FIRST TIME IN MORE THAN 20 YEARS. ANMF (Victorian Branch) Secretary Lisa Fitzpatrick described the historic pay deal as a symbol of the government’s commitment to recognising and rewarding nurses for their dedicated service. “For the last 17 years we have fought to protect patient safety through ratios. Nurse/midwife patient ratios are now law. “This time we were able to focus on fair pay and conditions and we have achieved that without taking significant industrial action for the first time in more than 20 years.”

Ms Fitzpatrick said the state’s 43,000

public sector nurses were delighted by the outcome. “Our members welcomed achieving such a great outcome after three and a half months of genuine negotiations compared to nine months of game playing by the previous Liberal government.”

Victorian Registered Nurse Jenny Singleton said the new pay deal would have a significant impact on the lives of nurses. Like many of her colleagues, Ms Singleton sported a red T-shirt with the campaign slogan Value Recognise Reward emblazoned on the back, throughout the negotiations in a demonstration of unity. “I am very proud to be a nurse and love my job. When news of the EBA agreement came through I was excited and relieved. Having been through two previous EBA’s I was not looking forward to what lengths we might have had to go to this time.”

“It was a great feeling to be given the parity pay with the NSW nurses without the fight and I truly felt appreciated and recognised for the difficult job we do.”

Victorian Health Minister Jill Hennessy said the agreement demonstrated the government’s awareness of the obligation to support the health system. “We’re delivering our nurses and midwives the wage justice they deserve and putting patient safety first.” anmf.org.au

NEWS

REDUCTION IN DOUBLE SHIFTS MISLEADING

The Australian Nursing and Midwifery Federation (Tasmanian Branch) has hit back at new data released by the Tasmanian government showing a reduction in double shifts across the state’s public hospitals, labelling the evidence as “misleading” and claiming it sidesteps the root cause of the health system’s workload woes.

Workload issues have plagued the state’s hospital system for several years and reached fever pitch last year with a troubling spike in the amount of double shifts undertaken by nurses due to insufficient staffing levels.

Last month, the Tasmanian government released encouraging data revealing a 50% drop in the amount of recorded double

shifts during the first three months of 2016.

Its figures spruiked 152 fewer double shifts at the problematic Royal Hobart Hospital, a reduction of almost 30%, and just 290 double shifts at the Launceston General Hospital, a reduction of more than half.

The government attributed the improvements in part to its introduction earlier this year of a 12-hour cap on nursing and midwifery shift lengths on the back of pinpointing fatigue as a major risk factor.

ANMF Tasmanian Branch Secretary Neroli Ellis noted that while the figures appeared progressive they in fact had merely passed the buck by shifting the problem across to overtime. “A policy to rename the shortages of employed nurses from double shifts to overtime is not addressing the problem. To announce that double shifts are decreasing while not revealing the concurrent increase in overtime is misleading.”

Ms Ellis claimed double shifts worked at the Royal Hobart Hospital last December were 155, yet after the implementation of the 12hour cap policy in January, figures actually rose to 158 in March, indicating that the problem was getting worse.

Ms Ellis said a Working Party established

The critical Inquiry unfolded throughout last year, with about 165 organisations and individuals making submissions, and the New South Wales Nurses and Midwives’ Association (NSWNMA ANMF NSW Branch) staunchly running its ongoing RN 24/7 campaign in a bid to protect registered nurses in aged care.

The subsequent report handed down on the back of the Inquiry backed the retention of legislation requiring at least one registered nurse be on duty at all times across the anmf.org.au

to tackle the ongoing workload demands faced by nurses had stimulated a “myriad of solutions” but added that few had been put into action and that progress had subsequently stalled. “It is still taking over three months to recruit a nurse into a vacant funded position and there has been no system improvement to reduce double shifts and overtime. There are simply not enough nurses employed to meet the increasing demand.” the final years of their lives.”

NSW GOVERNMENT ABANDONS RNS IN AGED CARE

The findings from a NSW Parliamentary Inquiry investigating whether registered nurses should be on duty around the clock across high care aged care facilities have fallen on deaf ears and been ignored by the state government.

TO ANNOUNCE THAT DOUBLE SHIFTS ARE DECREASING WHILE NOT REVEALING THE CONCURRENT INCREASE IN OVERTIME IS MISLEADING.

Mr Holmes said Australia’s ageing population would require more assistance with chronic and complex care needs in years to come and that “it simply doesn’t make sense” to remove essential safeguards such as RNs from the system.

He said the NSWNMA and the Australian Nursing and Midwifery Federation (ANMF) would continue to campaign fiercely against the implementation of looming legislative changes.

NSWNMA GENERAL SECRETARY BRETT HOLMES AT A RALLY LAST YEAR FOR RN 24/67 CAMPAIGN

state’s high care nursing homes.

Despite the clear-cut direction and proposals, the NSW government chose to turn their back on the findings and shift responsibility by advising that the state government plans to follow the lead of current federal legislation which does not require a registered nurse 24/7.

NSWNMA General Secretary Brett Holmes condemned the development, suggesting that the slow erosion of quality in aged care would lead to more neglect in the future.

“It’s very sad news for NSW’s elderly and families who rely on aged care facilities to operate to a standard of care that allows elderly to have a dignified journey through

Leading up to the federal election both NSWNMA and the ANMF are campaigning on the key issues for aged care including safe staffing and RN 24/7.

Aged Care expert Dr Maree Bernoth, a Senior Lecturer at the School of Nursing, Midwifery & Indigenous Health at Charles Sturt University who was among hundreds who made a submission to the Inquiry, said she was deeply concerned about the future standard of care that can be delivered to older people. “The number of submissions and the depth of those submissions indicates the level of concern for older people. It does make you wonder whether or not the Inquiry was just smoke and mirrors.”.

Dr Bernoth stressed that it was unfair to assume that all aged care providers would now lower their standards.

June 2016 Volume 23, No. 11 5

NEWS

SA MIDWIVES CALLED TO ACTION A South Australian MP has urged midwives to campaign against federal government cutbacks with the national breastfeeding hotline which will be without funding from 30 June.

Almost 50 midwives and consumers attended Parliament House in South Australia for the recognition of the International Day of the Midwife on 5 May. SA Member for Elder and Registered Nurse and Midwife Annabel Digance said the Australian Breastfeeding Association needed the $1 million federal government grant to survive.

“The federal government, in its wisdom, is only going to fund the Australian Breastfeeding Association’s 24-hour telephone counselling service until June this year. Make this a campaign and let those in Canberra know that this is not on.”

About 90,000 new mothers access the breastfeeding helpline.

SA midwives were formally recognised

by Parliament for their care and commitment. Ms Digance, who introduced the motion, said midwives provided “indisputably the best and most effective care model for pregnant women of all-risk profiles.

Congratulations to all who practice in this very privileged area of expertise, the profession of midwifery, and thank you from all of us here in the House.”

The state’s first university midwifery based pregnancy and parenting hub due to open in June was announced. The UniSA service will have eligible midwives provide care for antenatal and postnatal maternity care; and support midwifery students.

“I appeal to you all in your role as professional midwives: be vigilant, be confident, be proud of our profession and continually advocate on behalf of our profession,” Ms Digance said.

6 June 2016 Volume 23, No. 11

INQUIRY BACKS SUPER BOOST FOR WOMEN A comprehensive overhaul of superannuation policy is urgently needed in order to help make the system fairer for women, a federal Senate Inquiry examining the economic security of women in retirement has revealed.

The findings received positive feedback from long-time campaigners seeking to address the disparity between men and women.

Despite this the federal government’s 2016 Budget in May failed to fully incorporate the recommendations proposed within the Inquiry.

The Inquiry commenced last year and was undertaken by the Economics Reference Committee in a bid to help women achieve dignity and economic security in retirement.

Several key stakeholders, including the Australian Nursing and Midwifery Federation (ANMF) and superannuation fund HESTA made submissions to the Inquiry and appeared before hearings.

HESTA has about 230,000 members who earn under $37,000 per year and currently receive the low-income superannuation contribution.

“The focus on understanding that it is just accumulating poverty if women start off behind the eight ball in terms of pay parity was very pleasing,” Ms Delahunty said.

“Overall, it’s very promising and positive.

The concern is a potential focus on an individual response to that gap.”

Elaborating, Ms Delahunty said the report could lead the government to potentially lifting cap restrictions on women being able to top up their super, a move she views as evading the root problem. “We would see that as a real distraction from the root cause of why women have lower superannuation balances in the first place.”

Despite the Inquiry’s report outlining significant changes, the reforms in the 2016 Budget were seen as a welcome step with more work ahead.

HESTA’S GENERAL MANAGER BUSINESS DEVEOPMENT MARY DELAHUNTY

A final report, A husband is not a retirement plan – achieving economic security for women in retirement, was tabled in late April which made numerous recommendations. Chief among them was an overarching commitment to closing the gender pay gap, retaining the low-income superannuation contribution scheme, removing the current $450 threshold that allows employers to dodge paying super to workers earning under $450 per month, and payment of the Superannuation Guarantee (SG) on parental leave.

HESTA’s General Manager Business Development, Mary Delahunty, said the report acknowledged how issues such as pay rates and workforce participation directly derail a woman’s nest egg.

DECRIMINALISING ABORTION IN QUEENSLAND A Bill decriminalising abortion in Queensland was introduced to State Parliament last month.

The Bill, presented by Rob Pyne repels sections of the Criminal Code 1899 (QLD) which makes abortion a criminal offence for women and for the practitioner.

Abortion in Queensland is currently punishable up to 14 years imprisonment.

Data from the Australian Survey of Social Attitudes found 81% of Australians believed

a woman should have the right to choose whether or not to have an abortion. A 2009 Auspol found that four out of five Queensland voters were in favour of decriminalising abortion. The Bill is being supported by leading human rights lawyers.

“Women who seek abortions should not be treated as criminals and the majority of the Queensland public recognise that our laws need to change to reflect this,” said Australian Lawyers for Human Rights Queensland Co-Convenor Kate Marchesi. anmf.org.au

NEWS

BUDGET BACKLASH AS HEALTH IGNORED AGAIN Savage cuts to health carried out in recent years will continue to compromise the nation’s system after the federal government failed to offset the damage by again ignoring the sector and sidestepping any major funding announcements in its 2016 budget.

While the government injected $2.9 billion back into health funding, ANMF Assistant Federal Secretary Annie Butler likened it to “putting a Band-Aid on a severed limb” when taking into account the $57 billion previously slashed from the system.

Ms Butler said the snub would make it increasingly difficult for nurses and midwives to give appropriate care in hospitals and health services.

set to be wiped from Medicare as a result of cuts to bulk billing services for diagnostic imaging and pathology, due to come into effect in July.

Growing inequities in health and aged care, the methodical erosion of Medicare, and under-resourced health settings now present major challenges, Ms Butler added. “The nation’s healthcare costs are increasing as the population grows but this budget shows that the government lacks genuine commitment to building a stronger and healthier society. “We believe sustainable public health services could be achieved by creating a system which is evidence based and cost-effective.”

Palliative Care Australia (PCA) labelled the $1.2 billion plunge in aged care funding troubling and potentially detrimental to the level of care for people approaching end of life.

Australian Council of Trade Unions (ACTU) president Ged Kearney described the budget as a “missed opportunity” to address the enduring failure of the tax system to provide adequate support for hospitals, schools, infrastructure, and housing affordability. “In the past two years, the government has ripped $80 billion from planned investment in working Australians’ schools, hospitals, and other essential services. This budget returns a pathetic 5% ($4.1 billion) of that back. It’s a drop in the ocean.”

Measures within the budget that place further strain on the health system included the ongoing freeze on Medicare rebates, now pushed out until 2020, a $1.2 billion cut to aged care funding, and slashing $182.2 million from the health flexible funds, making it harder for patients to access essential programs tackling drug and alcohol abuse and rural health.

The budget strategies exacerbate previously announced cutbacks such as the $650 million anmf.org.au

“While we support being fiscally responsible, we call on the government to commit to closely monitoring the impact of this cut to ensure there is no reduction in the quality of care as a result,” PCA CEO Liz Callaghan said.

Disappointingly, the federal budget ignored the rural health sector, with little done to boost the $2 billion shortfall continually felt each year.

National Rural Health Alliance CEO Kim Webber said the last significant investment in rural health dates back more than 16 years to when a comprehensive rural health strategy was forged. “Attracting people to rural and remote communities for jobs and opportunities will open up more affordable housing and great lifestyle options. But people will not come and stay in rural and remote Australia if we do not have accessible health services.”

Leanne Wells, CEO of the Consumers Health Forum, warned that the overall budget package would hurt the hip pocket of patients who now face a battery of added costs under the new regime.

“These measures will discourage the sort of reform we need to support a primary healthcare system that would improve care for those with chronic and complex illness,” Ms Wells said.

Apart from direct health impacts to the nation, the budget also slashed $224 million from foreign aid, with the latest reduction following on from a $1 billion cut made last year.

CARE Australia Chief Executive Julia Newton-Howes said the decision was “deeply disappointing” and would damage Australia’s international reputation.

“Australia has turned its back on the world’s poor once again. The government’s refusal to reverse the final schedule cut to the aid budget means Australia will become the least generous we’ve ever been with the lowest ratio of aid to the size of our economy ever.”

Budget cuts • Freeze on Medicare rebates

until 2020

• Aged Care funding slashed by

$1.2 billion

• $182.2 million cut from Health

Flexible Funds, crucial programs tackling drug and alcohol abuse and rural health

• Abolishment of Child Dental

Benefits Scheme, hacking $1 billion out of federal dental spending

• $650 million in cuts to Medicare

by slashing bulk-billing incentives, announced as part of last year’s Mid-Year Economic and Fiscal Outlook (MYEFO)

• $224 million cut from foreign aid

June 2016 Volume 23, No. 11 7

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NEWS

TACKLING SUSTAINABILITY IN THE HEALTH SYSTEM Nurses and midwives can prove instrumental in driving change in the workplace that leads to a greater focus on addressing sustainability in the health system.

This sentiment was expressed by Registered Nurse Robyn Whiting, during her address on detailing significant recycling initiatives implemented at her workplace at the recent Health and Environmental Sustainability Conference held by the ANMF (Victorian Branch).

Ms Whiting, who works in theatre at the Royal Melbourne Hospital, became passionate about recycling several years ago after becoming alarmed at the amount of clinical waste that was being disposed of by the perioperative department.

She said gloves, gowns, coffee cups, anything and everything was being dumped.

Ms Whiting became proactive about change and quickly established a committee to tackle the issue and look at ways of reducing the hospital’s carbon footprint. The shift in culture led to significant changes

EN DIALYSIS TRIAL A second intake of enrolled nurses have been trained in dialysis under a new pilot program in the Northern Territory.

The trial at the Flynn Drive Renal Dialysis Unit started in January with three ENs trained to perform dialysis in the outpatient setting.

The push for ENs is to help meet escalating demand for renal services - predicted to grow by at least 4.5% per annum in Central Australia.

Northern Territory had the highest incidence of renal disease in Australia, Nursing Director of Preventable Chronic Disease and Ambulatory Services Carol McPherson said.

“The EN staffing model is complementary to our service. Historically it has been challenging recruiting registered nurses to the NT with the appropriate skills, knowledge and qualifications for the renal services.”

anmf.org.au

I DO BELIEVE YOU CAN MAKE A DIFFERENCE TO FUTURE GENERATIONS NO MATTER HOW SMALL. THERE IS A CULTURE NOW. IT’S ACCEPTED PRACTICE AND THEY [THE STAFF] ARE INSTRUMENTAL. ROBYN WHITING

within Melbourne Health’s perioperative departments, including dual bins aimed at encouraging staff to segregate waste and recycle. Key initiatives included PVC recycling, Kimguard recycling, and aluminium suture packet recycling.

Other improvements were made by switching from polystyrene cups to paper, recycling printer cartridges, and the removal of clinical waste bins at bedside and in anaesthetic treatment rooms. Polystyrene boxes used to transport surgical products are also now being returned to the company sender for disposal. Overall, the changes have led to significant cost savings.

Ms Whiting said change can occur if people come together and stand up for new policies. “I do believe you can make a difference to future generations no matter how small. There is a culture now. It’s accepted practice and they [the staff]

are instrumental.”

Also speaking at the conference Monash Medical Centre’s Director of Support Services, Sharon McNulty, and Registered Nurse Elizabeth Gillespie talked about the alteration and benefits of Monash Medical Centre’s award-winning cleaning without chemicals initiative within the Intensive Care Unit (ICU).

The initiative involves abandoning detergent and disinfectant and instead cleaning with water and microfibre cloths and mops. A steamer unit is now used to clean curtains as well as disinfect surfaces.

Cost savings of the implementation top more than $200,000. Crucial benefits have included reducing the use of detergent by 100%, water savings of 90%, and reducing the potential of bacteria being spread by traditional, double-dipping mops.

Changes to the Nursing and Midwifery Board of Australia allowing administration of medicines for ENs had opened up their scope of practice to work in a dialysis setting, Ms McPherson said.

EN Wendy Hume moved to Alice Springs from NSW. “I have always wanted to do dialysis since I did my EN training. I saw this advertised and thought I could get the cultural experience and have an amazing nursing experience.”

EN Abbey Conry, from Adelaide entered the hospital’s EN graduate nurse program a year ago. She was offered a position on the renal unit after she put renal down as a preferred placement. “The nursing is complex and convoluted. People we care for are in unique situations.”

Feedback from nursing colleagues, patients and other health professionals had been extremely positive, both ENs said. “The experience we have gained here we wouldn’t get anywhere else,” Wendy said.

Renal Society of Australasia President Kirsten Passaris said ENs already worked in dialysis units in other jurisdictions. “They are a very valued member of the team. I know ENs,

WENDY HUME AND ABBEY CONRY

working in dialysis if well supported and receive proper education are very happy. It’s an area in nursing where you form very good relationships with patients and their relatives.”

Anyone interested in furthering their career trajectory, can contact Carol McPherson at carol.mcpherson@nt.gov.au Anyone interested in joining the National Enrolled Nurse Association of Australia (NENA) email info@nena.org.au or visit www.nena.org.au June 2016 Volume 23, No. 11 9

NEWS REGISTERED NURSE DEL LOVETT

PRIMARY HEALTHCARE NURSES SHAPING MEN’S HEALTH Nurses working in primary healthcare have a responsibility in identifying health issues affecting men and engaging with them better in order to promote improved health outcomes, a leading men’s health advocate has emphasised.

Speaking at the Australian Primary Health Care Nurses Association (APNA) annual conference in Melbourne last month, Registered Nurse Del Lovett, who is currently completing a PhD on general practice nurses’ conceptions of men’s health, described primary healthcare nurses as an “untapped” resource that must do more to address men’s health.

Ms Lovett said a better understanding of men’s behaviour by primary healthcare nurses could lead to greater confidence in identifying the major issues affecting men, improved engagement, and ultimately, enhanced health outcomes. “Men’s health is everybody’s business, not just the GPs. We are the biggest number in the workforce in primary health care and we’re capable of extending what we do. Men use services later and at a later stage in their illness. They only come in if something’s about to fall or something major is wrong. This is where we have an opportunity to educate people earlier on.”

Outlining key initiatives and techniques primary healthcare nurses can adopt in a bid to engage men, Ms Lovett detailed

numerous strategies, including being mindful of making GP settings friendly, using simple language during consultations, adopting a frank approach, finding a hook to encourage men to talk about their health problems, and seizing the opportunity to communicate effectively with men whenever and wherever it presents itself. “The person has to be receptive to what we say. They take on board or don’t take on board what we say, however, the message has got to be very clear.”

Stripping the approach back, Ms Lovett said properly structuring a consultation is paramount from the beginning and delivers the best results. She said men typically live shorter lives than women and experience higher levels of avoidable mortality and major diseases including cancer, diabetes and suicide.

Typical health issues affecting men include drug use, body image, prostate cancer, postnatal depression and erectile dysfunction, she added.

Ms Lovett said one of the biggest deterrents to men accessing healthcare is ambivalence

“THE PERSON HAS TO BE RECEPTIVE TO WHAT WE SAY. IT’S CERTAINLY A TWOWAY STREET. THEY TAKE ON BOARD OR DON’T TAKE ON BOARD WHAT WE SAY, HOWEVER, THE MESSAGE HAS GOT TO BE VERY CLEAR.” and that primary healthcare nurses could play a crucial role in breaking down the barriers through active listening and teaching.

“Ambivalence is the key to changing health behaviour and central to this is finding that hook that will motivate a person to change.

Get them to look back at how it’s come about then get them to look forward to what could happen. Then work with them to work out the discrepancy between how bad it is and how much better it would be if they gave it up.”

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NEWS in 2008 (19.6%). Overall, almost four in 10 (39.7%) Indigenous people rated their health as excellent or very good.

SOCIAL FABRIC OF INDIGENOUS AUSTRALIA IN FOCUS

Other key points uncovered in the survey included Year 12 completion rates increasing.

The social and economic wellbeing of Aboriginal and Torres Strait Islander Australians has been revealed in a comprehensive survey that is expected to help shape future health policy and improve services.

Despite some progress, less than half (46%) of Indigenous people surveyed were employed, while one in eight Aboriginal people having being incarcerated during their lifetime.

IF THESE FIGURES AREN’T TRANSLATED INTO POLICY THEN THEY’RE FAIRLY USELESS AND JUST RHETORIC. IT’S REALLY ABOUT HOW THE DATA IS BEING USED TO INFORM POLICY

Undertaken by the Australian Bureau of Statistics (ABS) every six years, the 2014-15 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) was unveiled last month, with the review once again examining a range of issues including health, housing, education, unemployment, and cultural identity.

CONGRESS OF ABORIGINAL AND TORRES STRAIT ISLANDER NURSES AND MIDWIVES’ (CATSINAM) CHIEF EXECUTIVE OFFICER JANINE MOHAMED

In regards to health and wellbeing, the survey found smoking rates are on the decline, with 38.9% of Aboriginal and Torres Strait Islander people aged 15 and over classified as daily smokers, a drop from 48.6% in 2002 and 44.6% in 2008.

Congress of Aboriginal and Torres Strait Islander Nurses and Midwives’ (CATSINaM) Chief Executive Officer Janine Mohamed said the latest survey, coupled with the recent Closing the Gap report card handed down by the federal government, helped to add to a growing body of valuable evidence.

Alcohol consumption also fell, with one in seven (14.7%) of Aboriginal and Torres Strait Islander people aged 15 and over reporting exceeding the lifetime risk guidelines for alcohol consumption in 2014-15, down from 19.2% in 2008.

However, Ms Mohamed said while the statistics speak volumes, significant change could only occur with meaningful strategies.

“If these figures aren’t translated into policy then they’re fairly useless and just rhetoric.

It’s really about how the data is being used to inform policy.”

Similarly, there was significant improvement in mothers drinking during pregnancy, with results showing about one in 10 (9.8%) Aboriginal and Torres Strait Islander children aged 0-3 having had a mother who drank alcohol during pregnancy, half the rate back

CATSINaM Senior Policy and Research

Officer Colleen Gibbs said the organisation’s ideals of improving the recruitment and retention of Aboriginal and Torres Strait Islander nurses and midwives is substantially linked with the findings in the survey. “This information provides a context for why CATSINaM exists and why CATSINaM’s purpose is about cultural safety. If you don’t have a health system that’s culturally safe, you don’t get employment happening, and you don’t get the health outcomes happening.”

Ms Mohamed said Australia was starting to have fruitful conversations regarding breaking down the barriers that exist in accessing health services and education.

Nothing is more effective than Children’s Panadol *

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*Refers only to non-prescription medicines at the recommended Australian doses for paediatric paracetamol (15 mg/kg) and ibuprofen (10 mg/kg).

References: 1. Autret-Leca E et al. Curr Med Res Opin 2007;23:2205–11. 2. Walson PD et al. Am J Dis Child 1992;146:626–32. 3. Schachtel BP and Thoden MA Clin Pharmacol Ther 1993;53:593–601. 4. Celebi S et al. Indian J Pediatr 2009;76:287–91.

Children’s Panadol contains paracetamol. Use: For the temporary relief of pain and fever. Panadol is a registered trade mark of the GSK group of companies or its licensor. GSK Australia. 82 Hughes Ave, Ermington NSW 2115. GCB0034/ANMJ.

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20/05/2016 11:58 am

NEWS

PRIMARY HEALTHCARE NURSES CAN HELP PEOPLE DIE WITH DIGNITY

QUEENSLAND CEMENTS HISTORIC RATIOS LEGISLATION

A new smartphone app developed to help primary healthcare nurses map out informed management plans when delivering palliative care will improve outcomes for dying patients, a palliative care expert believes.

Addressing the Australian Primary Health Care Nurses Association (APNA) annual conference in Melbourne last month, keynote speaker Professor Liz Reymond, the Deputy Director of Metro South Palliative Care Services (MSPCS), said the PalliAGEDnurse app, launched on International Nurses Day last month, provides a major resource that should be utilised by the primary healthcare sector.

The core highlights of the app surround a care framework built around three key stages of care – advanced care planning, palliative care case conferencing, and a terminal care management plan. Following the framework, nurses would be able to appropriately cater to the patient’s needs depending on their level of decline.

Professor Reymond described nurses as the “lynchpin” of primary healthcare saying they had a significant role to play in helping people die with dignity. “A good death is really part of good healthcare and a good death in the community really does depend on your heart, your compassion, and your extraordinary nursing skills.”

Utilising a case study involving a 36-year-old woman with stage 4 breast cancer, Professor Reymond detailed the effectiveness of following a framework of care. Advance care planning presents an opportunity to find out what patients want throughout the palliative care process and importantly, their wishes when their own decision making becomes compromised.

“Case conferencing is really a dialogue between all people involved in the care and trying to keep everybody on the same page.”

Professor Reymond said many people undergo stages of denial before relenting and shifting their mentality to a terminal care management plan. “We have a duty of care to let them know the reality. People tend to swing between hope and despair and the idea is that we should not collude with false hopes. We need to be a source of truth as well as a source of hope.”

Professor Reymond said the new app, coupled with other resources such as palliative care online learning courses offered

by APNA and a 24-hour dedicated palliative care hotline, afforded a great opportunity for nurses to make a difference.

“A GOOD DEATH IS REALLY PART OF GOOD HEALTHCARE AND A GOOD DEATH IN THE COMMUNITY REALLY DOES DEPEND ON YOUR HEART, YOUR COMPASSION, AND YOUR EXTRAORDINARY NURSING SKILLS.”

12 June 2016 Volume 23, No. 11

Queensland has followed in the footsteps of Victoria to legislate landmark nurse to patient ratios that will make it mandatory for public hospitals to maintain minimum staffing levels.

Successfully passed in the Queensland Parliament last month, the Hospital and Health Boards. Safe Nurse-To-Patient and Midwife-ToPatient Ratios Amendment Bill 2015 will now make it mandatory for a minimum of one nurse to four patients for morning and afternoon shifts and seven patients for night shifts.

The ratios will be phased in from the beginning of July and elevate Queensland to just the fourth government in the world to legislate nurse to patient ratios.

The long-awaited legislation is viewed as a major step forward in the campaign to safeguard the quality of healthcare and produce better health delivery and outcomes.

Queensland Nurses’ Union Secretery (QNU, ANMF QLD Branch) Beth Mohle emphasised that every patient added to a nurse’s workload triggers a 7% increase in the likelihood that an inpatient could die.

“This legislation will save lives that need not be lost. International evidence concludes patient mortality outcomes are directly linked to nurse numbers and the level of care each patient receives.”

Ms Mohle believes the new ratios will lead to significant cost savings as a result of reduced healthcare costs, the improved retention of staff, and a drop in patient complications and adverse outcomes. She said the QNU would continue to work together with Queensland Health as the transition to the new ratios unfolds. “Queensland nurses, midwives and the Queensland Nurses’ Union have fought long and hard to better protect their patients so this is a historic day for us.

“Effective implementation of this legislation will be a marathon effort, not a sprint and we will continue to work very closely with Queensland Health to ensure patients get the best possible outcomes.”

It is anticipated that around 250 additional nurses will need to be recruited in order to meet the rollout of the increased ratios.

The Queensland government has pledged to review the changes once they have been in operation for a year and then consider whether the ratios should be extended to other wards and facilities or modified. anmf.org.au

NEWS

DISTRIBUTION OF SAFE INJECTING EQUIPMENT EASED

CHRONIC DISEASE INQUIRY FOCUS ON HOME CARE Implementing trials of a program designed to keep people out of hospital is a key priority, a Senate Inquiry on chronic disease recommends.

The Senate’s Inquiry into Chronic Disease Prevention and Management in Primary Health Care report was released last month.

The federal government announced in March, Health Care Homes as part of a package aimed to keep people with chronic diseases and complex conditions out of hospital. About 65,000 people will take part in two-year trials from July 2017. The government announced $21 million to support rollout of the trials.

ANMF Assistant Federal Secretary Annie Butler said while in principle the package could benefit the healthcare needs of Australians, she was also apprehensive on how the package would be implemented.

“There needs to be significant investment, underpinned by substantial planning and implementation into the Health Care Homes trial for it to be beneficial. If there is a piecemeal approach and or lack of planning I have grave concerns for its success.”

Consumers Health Forum (CHF) CEO Leanne Wells said it was essential to get the implementation of Health Care Homes right.

“This will need local clinical and consumer leadership and involvement in design and appropriate levels and models of funding.”

While the CHF welcomed the Health Care Homes initiative, more rock-solid commitment was needed, Ms Wells said. “We urge all politicians to rethink the fixation with hospital funding and focus on providing better organised and integrated primary, social and transitional healthcare in the community to reduce dependence on expensive hospital care.”

anmf.org.au

“The burden of chronic diseases is putting pressure on our hospitals making it difficult for families to receive the care they need,” Public Health Association of Australia Vice President David Templeman said.

THE BURDEN OF CHRONIC DISEASES IS PUTTING PRESSURE ON OUR HOSPITALS MAKING IT DIFFICULT FOR FAMILIES TO RECEIVE THE CARE THEY NEED

A new Australian Institute of Health and Welfare report released last month found a large percentage of chronic disease preventable. The Australian Burden of Disease Study 2011 shows at least 31% of the burden of disease is preventable if risk factors such as smoking, alcohol use and physical inactivity were tackled. Tobacco use accounted for 9% of the total burden of disease; alcohol use 5.1%; and physical inactivity 5%.

The report showed large inequities in lower socioeconomic and regional, rural and remote areas.

Senate chronic disease report key recommendations • Implementation of Health Care

Home trials

• Better data collection by Primary

Health Networks

• Increase in allied health treatments

available under Medicare; and direct referral between allied health providers and specialists in some cases • Improved privacy of patient records • Expansion of current Practice Incentive Program to include breast, bowel and skin cancer screening and Integrated Health Checks • Expansion of the electronic My Health Record

Peer distribution of sterile injecting equipment may soon be decriminalised in the ACT, after a Bill was introduced in State Parliament to clarify the issue. At present, it is unclear whether a person who provides sterile injecting equipment to another person has committed an offence under ACT legislation. The lack of clarity means people who inject drugs cannot keep their peers safe by providing sterile equipment without fear of criminal prosecution.

ACT Attorney-General Simon Corbell MLA described the move as “another step towards reducing the spread of blood-borne diseases such as Hepatitis C in the ACT.”

RATES OF CERVICAL CANCER DECREASING More than half of Australian women are participating in cervical screening programs according to new data from the Australian Institute of Health and Welfare (AIHW).

The report, Cervical screening in Australia 2013-2014, showed more than 3.8 million women aged 26-69 participated in cervical screening in 2013-2014, a participation rate of 57%.

AIHW spokesperson Justin Harvey said for all women, in the first ten years of the National Cervical Screening Program from 1991-2002, the rates of new cases and deaths have remained steady. In 2012, there were 725 new cases of cervical cancer diagnosed in 2013 and there were 149 deaths.

“These rates are low by international standards and one of the aims of the National Cervical Screening Program is to reduce cervical cancer cases, as well as illness and death from cervical cancer in Australia,” Mr Harvey said.

June 2016 Volume 23, No. 11 13

NEWS

Nursing museum curator Janie Mason launched a paper on ANZAC nurses on International Nurses’ Day in an event last month to mark their legacy.

Ms Mason, of Charles Darwin University, was in a group of 80 who retraced the footsteps of WWI ANZAC nurses in Athens, Salonika and Lemnos in Greece last year during ANZAC ceremonies. “It was a very intense experience. It was a very bleak

place, all of the nurses in their diaries talk about how bleak the peninsula is; and it still is. The stones and thistles and prickles and thorns went through our skirts and socks.”

‘An ANZAC journey from Adelaide River to Lemnos’ focuses on the WWI ANZAC nurses, places and cemeteries visited for the re-enactment last year. It includes the Mikra memorial and the 10 nurses who died aboard the British transport ship ‘Marquette’ which was torpedoed and sunk south of Salonica in the Aegean Sea in 1915.

The Island of Lemnos was one of the major evacuation points for the ANZAC retreat; it remains littered with connections to Australia, including war cemeteries, art galleries and art shows. About 40 of the Australian and New Zealand group dressed in costume and followed the footsteps

of the ANZAC nurses in 1915, to sense the hardships they faced while treating wounded soldiers.

“When the nurses arrived, there was no accommodation, they slept on the ground and set up the hospital,” Ms Mason said.

The response to the group from locals was overwhelming, she said. “The people of Lemnos came out of their cafes and welcomed us; they wanted us to stand next to the photographs they had of soldiers and nurses.”

‘An ANZAC journey from Adelaide River to Lemnos’ is available from the Historical Society NT. www.historicalsocietynt.org.au AHS CENTAUR

RE-ENACTMENT MARKS LEGACY OF NURSES

RE-ENACTMENT OF THE 1915 ANZAC NURSES LANDING AT TURKS HEAD ON MUDROS HARBOUR, LEMNOS (GREECE).

03/09/2015, PHOTOGRAPHER: ANDREW BATCHELOR. ACKNOWLEDGMENT: REPLICA UNIFORMS WORN FROM ANZAC ON GIRLS MINI-SERIES, 2014

MILITARY AND CIVILIAN NURSES REMEMBERED Australian military and civilian nurses who served in conflict were remembered last month.

A commemorative service held in Bathurst focused on the anniversary of the sinking of the Australian Hospital Ship (AHS) Centaur off Moreton Island, Queensland in 1943.

The Centaur was torpedoed while heading up the east coast of Australia to Papua New Guinea to pick up wounded soldiers; 268 died, including 11 army nurses. The 64 survivors, including one nurse, Sister Ellen Savage spent 35 hours in the water before rescued.

Charles Sturt University Professor of Nursing Linda Shields, a committee member of the Centaur Memorial Fund for Nurses, said though injured herself, Sister Savage 14 June 2016 Volume 23, No. 11

helped others. She was awarded the George Medal for bravery and courage. “Sister Savage’s actions personify what we are commemorating…dedicated to all nurses, both military and civilian, who have died while serving others. We know about the military nurses, finding civilian nurses is a little harder.”

Civilian nurses recognised include Rose Adelaide Wiles, 28, and Cecilia Elizabeth Bauer, 22, who died in 1905, after they sealed themselves off inside a sickroom in Maryborough Hospital to care for patients with pneumonic plague.

Four nurses on the way to the battlefields in France in 1918 volunteered to work with returning soldiers with influenza and died on their return while in quarantine in Fremantle.

Sister Vivian Bullwinkel who volunteered as a nurse with the Royal Australian Air Force and was rejected for having flat feet, joined the Australian Army Nursing Service.

She was the only remaining survivor after the sinking of the Vyner Brooke carrying evacuees including the last 65 Australian nurses in Singapore in 1942. She survived the subsequent massacre of the ship’s survivors on Radji Beach. anmf.org.au

L-R DOT ANGELL AND HELEN TAPLIN. PHOTOS: SUSAN GORDON-BROWN

NEWS FEATURE

FIGHT FOR RECOGNITION LIVES ON Nurse Dot Angell was a free-spirited 20-something when she answered the Australian government’s call for civilian volunteers to head over to Vietnam in the thick of war and serve in the relief effort.

It was 1967 and Dot became part of the Alfred Hospital’s civilian surgical and medical team who would spend several months at the Bien Hoa Provincial Hospital tending to anything and everyone who walked through the door.

The project was run under the umbrella of the South East Asia Treaty Organisation, known as SEATO, with more than 450 nurses, doctors, and other health professionals, signing up to the cause.

The civilian teams had begun journeying to Vietnam in 1964, much earlier than Australian troops. “Nobody said anything to us.

Nobody told us what it would be like,” says Dot, now 75. “Being young and having just got back from three and a half years overseas and it being the Swinging Sixties I was young and foolish and decided it would be an adventure so I volunteered.”

Dot recalls working around the clock in a race to treat the scores of patients caught in the crossfire of war. “We treated anybody who came through the gates at the hospital, whether they were friend or foe. We were dealing with war injuries. We were dealing with traffic accidents because Bien Hoa was a refugee town and packed to capacity.

We also dealt with illnesses, some of which we had never seen before, such as plague, typhoid, and cholera.”

Dot was part of the last of the Alfred squads to head to Vietnam and her crew handed over the reins to a unit from South Australia.

When she returned home it was business as usual.

Decades later, while undertaking a PhD and interviewing a handful of civilian nurses that served in Vietnam, Dot suddenly realised that many of them were experiencing the same health conditions suffered by military forces such as cancers and Post-Traumatic-StressDisorder.

This led Dot to establishing a special interest group in 1998 and embarking on an unwavering campaign demanding recognition for civilian nurses who served in Vietnam and claims to the same health anmf.org.au

entitlements accessed by the military under the Veteran’s Entitlement Act 1986 (VEA).

Dot and many like her are adamant that the toll of Vietnam remains profound, with many nurses suffering cancers including lung, bowel, and breast cancer, as well as nightmares and flashbacks associated with Post-TraumaticStress-Disorder. Almost two decades on from attempting to seek compensation from the government, the battle for medical care and entitlements lives on.

The government has acknowledged the contribution of civilian nurses who worked tirelessly in Vietnam to save the lives of many but is adamant that provision for assistance is available by making a claim for worker’s compensation under Comcare.

Comcare, however, is viewed as insufficient and stops at the age of 65, meaning many nurses are ineligible.

In the early 2000s a handful of government reviews, chiefly the Inquiry conducted by Major General Justice Mohr, found civilian teams were suffering higher rates of illnesses than in the general community and had performed services that should qualify them for repatriation benefits. But subsequent reviews quashed the evidence.

“I think the government is hoping that we’ll all die out,” Dot says bluntly.

Dot, who suffers from two autoimmune disorders and Post-Traumatic-Stress-Disorder, which she attributes squarely to her time in Vietnam, says the close-knit group of civilian nurses remain steadfast in their commitment.

“The most important thing is that it should never happen again, civilians being asked by the government to go into war zones and governments then washing their hands of them.”

The Australian Nursing and Midwifery Federation (ANMF) has backed the nurses’

plight since the campaign began and says it will continue to support their right to claim benefits. “These brave nurses went above and beyond to work in demanding conditions in a relief effort assembled by the Australian government,” ANMF Federal Secretary Lee Thomas said. “Their service deserves full entitlements and anything less is a slap in the face.”

Civilian nurse Helen Taplin, now pushing 80, echoes the sentiment. “I just think it’s disgusting really,” she says of being abandoned by the government.“I can’t see why they discriminate from civilians.”

Helen spent six months at the Bien Hoa Provincial Hospital as part of the relief effort.

Working in a basic hospital crammed with people, she treated horrific injuries, such as children who were without limbs after having stood on landmines.

“It’s in the back of your mind. You don’t forget it,” Helen says. “They were some pretty horrendous things which we still remember.”

Helen has suffered from cancer of the bowel and autoimmune problems and believes Vietnam is the missing link. “I had a feeling it may have [caused my illnesses] because nobody in my family have suffered anything like this.”

While the frustration of dealing with a government that largely ignored her plight is sobering Helen says there are some positives, such as the annual Anzac Day march in Melbourne where nurses catch up on old times and regroup over their common cause.

Helen says she has no regrets about volunteering in Vietnam and would jump at the chance to do it all over again, with the courage and heart of the Vietnamese people she met still filling her heart with warmth all these years later. “I think about it all the time. I just often wonder where these very special people are.”

June 2016 Volume 23, No. 11 15

FEATURE

ICareandIVote

FEDERAL ELECTION 2016: IF YOU DON’T CARE, WE CAN’T CARE There is one month before the Australian community take to the polls to vote.

The ANMF’s message is loud and clear: it’s now up to the Australian public. Vote for health funding. Vote for Aged Care. Vote for Penalty Rates. Vote for Medicare. Tell your politicians, If you don’t care; we can’t care. $57 billion in cuts to healthcare If this huge figure proposed by the government is carved from our health system the damage to patient care will be devastating.

Aged care Without appropriate staffing levels and resources it’s impossible to provide the level of care that our elderly relatives deserve.

Cuts to nurses’ and midwives’ penalty rates Nurses, midwives and assistants in nursing depend on overtime pay and penalty rates to earn a fair wage and to compensate for the unsociable hours they work, it’s only fair.

Medicare funding freeze The 2015 federal budget will freeze Medicare rebates for GPs forcing them to pass on increased costs to patients. A further $650 million funding cut will force increased costs for x-rays and other diagnostic tests. All parties must confirm their support for our universal healthcare system and stand up for Medicare.

16 June 2016 Volume 23, No. 11

anmf.org.au

FEATURE AGED CARE MORE STAFF, SAFER ENVIRONMENT, BETTER CARE – SO SIMPLE The ANMF has lobbied and campaigned fiercely for aged care, for: better wages; mandated staffing levels and skill mix; financial transparency and accountability; and the regulation of assistants in nursing.

The 2015 Intergenerational Report projects within the next 40 years, there will be approximately 40,000 people aged 100 and the number of people aged 65 and over will have doubled in Australia.

care possible to Australia’s frail elderly.”

When the federal government was elected three years ago, one of its first acts was to abandon the $1.2 billion allocated for aged care wages and training, Ms Thomas says.

“And again, this last Budget offers nothing to restore that, at a time when there’s a shortfall of 20,000 nurses to care for elderly, vulnerable Australians.”

The NSW Parliament last month rejected the findings of a state Inquiry which recommended keeping the legislative requirement for nursing homes to have a registered nurse on duty 24 hours a day, seven days a week.

and a primary healthcare package for the chronically ill. “This measure goes less than halfway to addressing the cuts to expected public hospital funding from 2017 to 2020 which were flagged in the 2014 and 2015 Budgets,” Australian Health and Hospitals Association (AHHA) Chief Executive Alison Verhoeven says.

“After the government previously slashed $57 billion from the country’s public health funding, the $2.9 billion being promised in the Budget for health won’t go anywhere near ensuring that the states and territories’ hospitals can operate effectively and efficiently,” ANMF Assistant Federal Secretary Annie Butler says.

The increased health and personal care needs of individuals will require a sufficient and qualified, skilled workforce, ANMF Federal Secretary Lee Thomas says. “Put simply, the elderly cannot receive proper care unless there is an appropriate number and mix of skilled and experienced staff, which includes registered nurses, enrolled nurses and assistants in nursing/personal care workers.”

“We have mandatory staff ratios in our hospitals, childcare centres and schools, so why should nursing homes be any different?”

Combined Pensioners & Superannuants Association of NSW (CPSA) Senior Policy Adviser Ellis Blaikie says.

“Without legislated requirements in all Australian jurisdictions to mandate a

The AMA Public Hospital Report Card 2016 showed the performance of Australian

A Senate Inquiry is currently underway on the Future of Australia’s aged care sector workforce. It will determine projected workforce requirements and the challenges in recruiting and retaining staff to the sector.

“The groundswell of opinion is that there are significant issues that must be addressed as a matter of urgency. There is simply a lack of will by governments and industry to do this,” Ms Thomas says.

minimum number and type of nursing and care staff in the aged care sector, safe and quality care for the elderly cannot be assured,” Ms Thomas says.

public hospitals was virtually stagnant and in decline in key areas. A direct consequence of reduced growth in the Commonwealth’s funding of public hospitals, Professor Owler said. “Bed number ratios have deteriorated.

Emergency department waiting times have worsened. Public hospital performance has not improved overall against the performance benchmarks set by all governments.”

Issues include low wages and poor conditions; inadequate staffing levels and workload; unreasonable professional and legal responsibilities; lack of career opportunities; stressful work environments; poor management practices; and a poor perception of aged care (ANMF’s submission to the Senate Inquiry, March 2016).

Barriers to working in the aged care sector must be urgently addressed, Ms Thomas says. “The pay for the majority of aged care workers, both skilled and semi-skilled, simply does not reflect the nature of the work and the level of responsibility required nor does it value the importance of providing the best anmf.org.au

The lack of formalised educational and competency requirements for the unregulated aged care workforce put the protection of frail aged care residents at risk, Australian College of Nursing CEO Kylie Ward said. “The clinical complexity of residents entering aged care facilities is increasing, with the care requirements of residents often complicated by multiple comorbidities, polypharmacy, geriatric syndromes and cognitive impairment.”

HEALTHCARE FUNDING $4.2 BILLION RIPPED FROM HEALTH IN EIGHT MONTHS Two successive budgets saw $57 billion stripped in Commonwealth funding for health.

Though Federal Health Minister Sussan Ley recently announced $2.9 billion for hospitals

“Public hospital funding is about to become the single biggest challenge facing state and territory finances – and the dire consequences are already starting to show,” AMA President Professor Brian Owler said.

Growth in Commonwealth funding is capped at 6.5% per year. From July 2017, growth in Commonwealth funding will be restricted to indexation using CPI and population growth only.

On top of this, the latest Budget has cut another: • $182.2 million from the health flexible funds – for health programs tackling drug and alcohol abuse, chronic disease, communicable disease and rural health issues.

• $1 billion out of Commonwealth Dental spending with abolition of the Child Dental Benefits Scheme.

June 2016 Volume 23, No. 11 17

FEATURE MEDICARE MARCH FOR MEDICARE: IT’S WORTH DEFENDING

Freezing Medicare rebates over the next three years was on top of the $1.3 billion already removed.

Unions held a street theatre event in Sydney last month to signal the race is on to stop the $650 million of cuts to Medicare. City workers were entertained while informed.

Patients are expected to be further hit by the extension of the pause in the indexation of the Medicare Levy Surcharge and the Private Health Insurance Rebate thresholds – a further saving of $370.9 million.

“People won’t know what hit them when we reach July and the pathology company suddenly starts asking them to hand over their credit card,” NSW Nurses and Midwives’ Association (NSWNMA, ANMF NSW Branch) General Secretary Brett Holmes said.

“The government has neglected to strengthen Medicare and provide an adequate level of funding which would support nurses and midwives working in under resourced public health settings and guarantee their high standard of care delivery,” ANMF’s Annie Butler says.

In Budget 2014, the federal government tried to unravel Medicare with the proposed introduction of a GP co-payment. After several unsuccessful attempts to destroy Australia’s universal healthcare system, many believed the fight for Medicare was won.

The government has already come under fire for lack of transparency around plans for a sell-off of the Medicare payments system to a private, overseas based multinational.

Concerns have been raised of where patient data would be kept and the threat of loss of jobs of 1,400 call centre staff around Australia. “Medicare absolutely needs to stay

In Budget 2015, the Abbott government

announced a four year freeze on Medicare rebates. Doctors warned they would be forced to push this cost on to patients and could lead to even higher charges than the failed GP tax.

In the latest Budget 2016, the government announced an extension of the current freeze of the Medicare patient rebate until 2020. This is an estimated cost saving to the government of almost $925 million; a move condemned by the ANMF and the AMA. “Australians already suffer one of the highest out of pocket costs for healthcare anywhere in the world and this will only worsen with the government continuing to reduce rebates for a range of services and privatising parts of Medicare – cynically shifting the cost burden onto consumers,” ANMF Assistant Federal Secretary Annie Butler said.

A GP tax in place for another two years is a measure to drive down bulk billing and force patients to pay more, says Consumers Health Forum CEO Leanne Wells

18 June 2016 Volume 23, No. 11

in public hands,” CPSU Deputy Secretary Melissa Donnelly says. “Privatising Medicare payments would mean handing control of a system that we all rely on to a private company that would not be answerable to the Australian public.”

PENALTY RATES Unions and the community have rallied against the federal government’s attack on penalty rates - veiled in a review of Australia’s workplace relations system.

The government ordered a Productivity Commission Inquiry into the IR system in 2013 – despite a comprehensive review only three years earlier which found the system working well.

The Productivity Commission (PC) handed down its long-awaited final report into penalty rates late December. Despite rallies and active campaigning across Australia, the PC recommended the introduction of a twotiered system for the retail and hospitality sector: a subsequent cut to penalty rates.

While the recommendation did not extend to frontline workers including nurses and midwives, ANMF Federal Secretary Lee Thomas said there was no guarantee that nurses and midwives wouldn’t be next.

“The ANMF supports the rights of all workers to have penalty rates paid to them.

It’s only fair that workers are adequately compensated for working unsociable hours, whether that’s at night, on weekends or on public holidays.”

“For most Australians, productivity and flexibility are just fancy words for doing more with less, working harder and longer for the same pay,” ACTU President Ged Kearney says. “At the most fundamental level, our workplace system is based on a broad and enduring social consensus: that workers’ rights must be protected and there is a role for policy intervention to ensure they are rewarded equitably for their efforts.”

Nurses, midwives and carers rely on penalty rates for 20% of their income. In all states other than Victoria a first year Registered

Nurse working in a public hospital would lose $1,921 a year in wages if their Sunday penalty rates were cut to Saturday levels (The McKell Institute, 2015). Collectively, nurses, midwives and aged care workers would lose over $359 million a year if Sunday penalty rates were reduced to Saturday levels and a further $3 billion would be under threat if changes went further.

Analysis by the ANMF SA Branch revealed that a one-third cut to penalty rates could reduce the pay of a registered nurse (Level 1, top pay increment) by $146 per week; with the total loss of penalty rates a $439 weekly pay cut.

More than 13,000 nurses and midwives responded to an ANMF survey on penalty rates last year. Almost nine in 10 respondents said they would stop working shift work if penalty rates were lowered or cut. An overwhelming 93% warned they would take industrial action over penalty rates.

anmf.org.au

FEATURE

IF YOU DON’T CARE, WE CAN’T CARE The ANMF’S campaign; If you don’t care; we can’t care is calling on major political parties to care about the health system, but we need your help. Here is what you can do:

Keep informed: • Visit the campaign website www.ICareandIVote.com.

au for regular updates and calls to action

• Join the campaign’s facebook /ICareandIVote page and

engage in discussions

Speak to your community: • Contact your local MP and tell them how important

healthcare is for you. Visit www.ICareandIVote.com.au website page for steps on how to contact them.

• Talk to colleagues and people in the community about how cuts to our healthcare are detrimental to all

AUSTRALIA SNAPSHOT

NORTHERN TERRITORY - $600 million – equivalent to 60 hospital beds or one Palmerston Hospital

QUEENSLAND - $11.8 billion – equivalent to funding 2,895 nurses, 818 doctors, and 824 health professionals

Australia snapshot – $57 billion in health cuts across the country

NSW - $17.7 billion – a loss of five-anda-half Westmead Hospitals

WESTERN AUSTRALIA - $5.7 billion

ACT - $1 billion

SOUTH AUSTRALIA - $3.5 billion – equivalent to closing down 600 hospital beds

VICTORIA - $17.7 billion – equivalent to losing two tertiary hospitals TASMANIA - $1 billion

Source: PBO Parliamentary Bridge Office. Submission to the Senate Select Committee of Health rewarding commonwealth funding of private hospitals: Feb 2016

anmf.org.au

June 2016 Volume 23, No. 11 19

FEATURE

WHY POLITICIANS MUST CARE: ANMF SECRETARIES SPEAK OUT ANMF Federal Secretary Lee Thomas “By abandoning health funding yet again the federal government has demonstrated its lack of understanding of the importance of health and the need for adequate funding so that nurses and midwives can deliver quality care to their patients.

Frontline nurses and midwives are feeling the brunt of the growing inequities in healthcare which are worryingly compromising the standard of care able to be delivered.”

“The nation’s health system will continue to deteriorate unless the bleeding stops.

We need a genuine commitment to protecting health and ensuring a stronger and healthier society for years to come.

“The threat to penalty rates, which most nurses rely on to get by, rounds out the brutal attack on health in this country.

“We are asking that all political parties commit to a partnership with key stakeholders, such as the ANMF, to ensure an appropriate and robust healthcare system is widely accessible to all Australians, now and into the future.”

ANMF NT Branch Secretary Yvonne Falckh “The freezing of the Medicare rebate for a number of years by the federal government will impact largely on those that can least afford it. GP practices that currently bulk bill may rethink this service to their patients as their expenses increase.

Those on lower incomes and those on welfare payments will be hardest hit. We protested about the $7 Medicare co-payment, yet by stealth the federal government will introduce out of pocket payments for pathology tests, radiology and increases to prescription payments.”

ANMF Assistant Federal Secretary Annie Butler “Australia’s public health system is under major threat. The federal government seems determined on crippling the ability to provide quality care by dodging its responsibility to restore national health funding in the aftermath of savage cuts imposed in recent years. It’s clear that the rising challenges we face in health are being completely ignored across the board.

ANMF SA CEO/ Branch Secretary Adjunct Associate Professor Elizabeth Dabars

“The Medicare rebate freeze is likely to see more people end up in hospital because people will avoid visiting their GPs due to inflated costs.

“The federal government cut $57 billion in growth from public hospitals in its 2014 budget. In SA that is equivalent to nearly a whole health region with three hospitals losing its funding by 2024/5. South Australians cannot receive adequate and appropriate healthcare with those levels of funding cuts.

“Aged care seems to be invisible when it comes to appropriate funding, safe staffing and government policy. The sector is constantly burdened with financial cut after financial cut with little regard for the welfare of older Australians. It’s imperative we stand up for this sector and let our politicians know that older Australians deserve more.”

“Almost weekly we are receiving reports from members about cuts to hours in aged care facilities. These cuts come on top of existing staffing levels and mix that are inadequate to meet residents real care needs. We need urgent action to ensure that funding to aged care is based on ensuring that adequate and appropriate staffing levels are available to support and care for residents.”

20 June 2016 Volume 23, No. 11

ANMF Tas Branch Secretary Neroli Ellis “Tasmanian nurses rely on penalty rates as part of their package as compensation for missed family time.

They have no choice but to work weekends and afterhours and deserve to receive compensation.

“Skill mix and staffing numbers are woeful in Tasmania and we must stand up for our ageing population to ensure those needing more complex care, have access to the right staffing skill mix. The aged care nursing teams are struggling with more responsibility being put on to the care staff due to substitution of nurses to minimise the bottom line, not aiming to maximise resident outcomes.” anmf.org.au

FEATURE QNU (ANMF QLD Branch) Secretary Beth Mohle “The threat to penalty rates is merely part of a broader national and global effort by employers to maximise profits by driving down wages and conditions. It’s also about employers attempting to gain more ‘employment flexibility’ by replacing permanent, secure work with casual, insecure work. But we live in a society, not an economy – and many Australians work unsociable hours to keep our society functioning, to ensure we all have access to services when we need or want them.

By first targeting retail and hospitality workers - those workers who will find it more difficult to organise and speak up against this unfair attack - it’s just a matter of time before they target our own (nurses and midwives) penalty rates.

“There is a troubling downward trend in direct care staffing in aged care. In the 2008-2009 financial year, aged care providers nationally spent about 66% of their Commonwealth funding on direct care staffing costs. In the 20112012 financial year, this figure had dropped to 60%, and in 2014-2015, it dropped further to 55%. This pattern of continual reduction in proportional spending on direct care staffing costs is of serious concern.”

NSWNMA (ANMF NSW Branch) General Secretary Brett Holmes “Of the $57 billion cuts in federal funding for public hospitals, NSW is set to lose $17.6 billion over an eight year period – the most of any state or territory. This is equivalent to the entire NSW hospital budget for a whole year. We obviously can’t shut down the public hospital system for a year but we certainly need more than a portion of the $2.9 billion announced in the 201617 Budget if we’re to keep up with the growing demand on services year-on-year.

“The story doesn’t get much better. We’re still defending Medicare and staging rallies in NSW to inform the public about what the cuts to bulk-billing mean. Our social media campaign, the race to save Medicare, is counting down to 2 July with informative memes around specific tests that will be affected.”

ANMF ACT Branch Secretary Jenny Miragaya “We have recently seen an increased devaluation of the work performed by members who are required to work unsociable hours, outside of normal business hours, at night, on the weekend and on public holidays. I ask the politicians will you and your party defend current penalty rates, rates for weekend work, shift work and overtime, both for so called essential workers, such as nurses, midwives, firemen and paramedics, but also for all those workers, working in perceived less valuable occupations, such as in the retail and hospitality industries but who are also required to work unsociable hours, outside of normal business hours, at night, on the weekend and on Public Holidays?

ANMF Vic Branch Secretary Lisa Fitzpatrick “The game of health Budget political ping pong means millions of Victorian patients will miss out on hospital care when they need it. As soon as the Andrews Victorian government injects additional millions into Victoria’s health budget, the Turnbull government takes it out. Victorian hospitals lost $73 million this year alone and will have to try and do more with $17.7 billion less over the next decade. It’s not sustainable. anmf.org.au

June 2016 Volume 23, No. 11 21

FEATURE

WHAT THE POLITICAL PARTIES SAID ON HEALTH “The government has provided an additional $2.9 billion in public hospital funding over the next three years through an agreement with the states and territories that places greater focus on patient outcomes, particularly when it comes to caring for patients with chronic and complex needs.

“We have a clear focus on integration, innovation and modernisation to deliver the 21st century health services Australians expect. We will eliminate waste, inefficiency and duplication wherever we find it.”

PROTECTING MEDICARE “The government is strengthening Medicare through the new Health Care Homes initiative, which will better coordinate comprehensive care for chronically ill patients.”

AGED CARE “The Turnbull government will continue to deliver consumer-centred aged care services, with reforms that will improve access in rural and remote locations, as well as $136.6 million to ensure the My Aged Care website can meet rapidly growing demand.

“The current aged care funding model will also be improved by redesigning certain aspects of the Aged Care Funding Instrument to stabilise higher than expected growth.

“These measures are part of the Turnbull government’s ongoing commitment to broader aged care reform.”

PENALTY RATES “The government’s position has been and continues to be that penalty rates are determined by the independent Fair Work Commission.”

HEALTH “Labor is the only party that stands for the right of all Australians to affordable healthcare, regardless of income or background.

“If elected Labor will restore indexation of the Medicare Benefits Schedule from 1 January 2017 “We’re the party that created both Medicare and the Pharmaceutical Benefits Scheme, both of which vastly improved Australians’ access to quality healthcare.

“Because of Labor there are more doctors, more nurses and a record number of GPs and nurses being trained.”

PROTECTING MEDICARE “Labor created Medicare and only Labor believes in Medicare. We won’t accept an American style system where your credit card matters more than your Medicare Card.

“While in government we invested more in healthcare than any previous government and delivered the highest levels of bulk billing in Australia’s history.”

AGED CARE “In government, Labor made ageing and aged care a national priority, consulted widely, worked collaboratively and introduced the [Living Longer Better] reform package with bipartisan and extensive community support.

“A Shorten Labor government will put the Living Longer Better reforms back on track.

“Labor understands that the frontline workers are the key to providing quality care and services.”

HEALTH “The Greens would invest an extra $1.5 billion in Commonwealth funds into the public hospital system over three years.

Thirty per cent would be allocated to rural and regional hospitals many of whom who are already struggling.

“The Greens commit to transparent and fair Commonwealth funding of hospitals.”

PROTECTING MEDICARE “The Greens support Medicare as a universal, publicly funded health insurance system for all Australians, funded from progressive taxation.

“We recognise that adequate access to bulk-billing GPs across Australia and greater access to healthcare delivered in locally run community health centres are essential and must be protected.”

AGED CARE “The Greens’ plan for older Australians is to ensure that older Australians can access the services and support they need in each of the major policy areas: employment, healthcare, housing and more.

“We are committed to delivering affordable, appropriate aged care, including over 65s in the NDIS, supporting human rights, and opposing ageism and elder abuse.”

PENALTY RATES “Penalty rates are recognition of the unsociable hours that many people work.

Many people, especially young workers, rely on penalty rates to earn a living wage.

“There are a range of ways the pressure can be taken off small business without changes to rights and protections of workers.”

PENALTY RATES “In Opposition, Labor has already taken the unprecedented step of making a submission to the Fair Work Commission arguing that penalty rates must not be cut.

“Labor understands that penalty rates are not a luxury; they are what pays the bills and puts food on the table for the 4.5 million Australians that rely on them.”

ICareandIVote

22 June 2016 Volume 23, No. 11

anmf.org.au

WORLD

PARTNERSHIP PAVES THE WAY FOR BETTER HEALTHCARE IN TANZANIA

By Chad Martino

Words can’t describe how much of a privilege it was to go and meet such humble people.”

Although strategic health education programs are the core platform of GHAWA’s focus, opportunities have arisen to allow GHAWA to expand its assistance and deliver support in a variety of other ways.

This includes working with mining resource companies and villages on corporate social responsibility, providing clean water in villages, and the donation of medical supplies and equipment.

While Tanzania is currently the primary focus for GHAWA, interest is building from other health agencies and governments such as Zambia, Malawi, Zimbabwe, Sri Lanka to partner with the organisation.

“The challenge will always be the ability to fund new partnerships – and there is always more to be done,” Ms Ng said.

An innovative partnership spanning two continents is helping to transform healthcare in one of Africa’s most populated cities.

Known as the Global Health Alliance Western Australia (GHAWA), the partnership is underpinned by a program that has delivered professional development education to more than 1,850 local health workers – primarily nurses and midwives – in the Tanzanian capital, Dar es Salaam.

Formed in 2010, by the WA Health Department’s Nursing and Midwifery Office, GHAWA was created to proactively contribute to the United Nations Millennium/ Sustainable Development Goals of promoting wellbeing, reducing child mortality and improving maternal health.

GHAWA’s Program Lead Jenni Ng said the partnership was one of the WA Department of Health’s biggest success stories.

“Through this program we have been able to help build the capacity and capability of the nursing and midwifery workforce in Tanzania,” Ms Ng said. “Health workers from Tanzania’s Muhimbili National Hospital, Muhimbili Orthopaedic Institution, Amana, Temeke, Myananyamala, Kairuki, and Kisarawe Hospitals – including two rural primary health centres at Masaki and Masanganya – have already accessed the program and continue to do so in 2016.

“Short courses on maternal and child health, emergency and acute care, and infection prevention are all delivered on site and provided at no charge to staff. anmf.org.au

“With the UN reporting a 45% decrease in maternal death rates since 1990, programs such as GHAWA are making the right impact where it’s needed most.”

While the GHAWA program has resulted in significant benefits for Tanzanian health professionals, Ms Ng said the benefits to WA’s health workers could not be underestimated.

“We have staff that travel to Tanzania to volunteer for up to a month at a time, and the reciprocal experiences and knowledge gained during this time is invaluable.”

“However, GHAWA was created as an alliance program to give us a vehicle to allow additional funding to be obtained from other NGO’s, outside of government.“Given the success of the program to date, it won’t be long before we see this important program established in other countries across the globe.”

For more information about the Global Health Alliance Australia visit: www.globalhealthalliance.com.au/ Chad Martino is Principal Media Coordinator, Communications Directorate|Office of the Director General, Department of Health in WA

GHAWA’s success in Tanzania

For many of our students and healthcare professionals, the opportunity of working abroad promotes a greater appreciation and experience of working in what can be a sometimes challenging environment.

• delivered 146 professional

“Factors such as cultural understanding, leadership and creating practical solutions in the field are qualities developed or realised from within. For example, in more developed countries we often rely on technology to help us deliver the best healthcare we can. However, placed in a situation without this luxury, brings our core nursing qualities to the fore where initiative and adaptability is required.”

•

Student nurse, Nicole Beer from WA’s University of Notre Dame, travelled to Tanzania in November 2015 and echoed Ms Ng’s views about the importance of experiencing different types of healthcare around the world. “My experience in Tanzania was like no other. It changed the way I think about global healthcare and it gave me a new appreciation for what we have in Australia.

•

“The situations we faced required quick thinking with very limited resources available.

•

• •

•

development education and training more than 1,850 local Tanzanian health professionals; rehabilitated and built water wells at Masanganya; painted the Masanganya primary school and provided health education at the school to the children and community; assisted Muhimbili Midwifery School with curriculum development; facilitated 97 WA undergraduate nursing students and 24 supervisors to undertake collaborative clinical placements in Tanzania; procured two ambulances for the primary healthcare centre at Masaki and Masanganya in rural Tanzania; trained local Tanzanian drivers and patient escort nurses who now provide a solution to the challenge of urgently transporting patients in need of medical care.

ABOVE IMAGE: GLOBAL HEALTH ALLIANCE WESTERN AUSTRALIA PROGRAM LEAD JENNI NG AT THE PWANI REGION RURAL HEALTH POST WITH CHILDREN FROM THE MASANGANYA COMMUNITY, TANZANIA.

June 2016 Volume 23, No. 11 23

INDUSTRIAL

REGULATION IN DANGER During this federal election campaign, the Coalition government is counting on its crusade to bring back the Australian Building and Construction Commission to dominate the public discussion on industrial and workplace matters. In doing so it hopes to distract us from other plans and policies on their agenda that will impact directly on the living standards of working people, their workplace rights and workplace laws.

Debbie Richards, Federal Industrial Research Officer

You may recall following the last election, the Coalition government commissioned several reviews into workplace laws, employee entitlements and the regulation of unions including the Productivity Commission’s Inquiry into the workplace relations framework.

While the terms of reference were very broad, the Inquiry was clearly established to give the Coalition government and their supporters in the business community the ammunition to attack penalty rates and the safety net of wages and conditions established under the current system of workplace regulation.

The two volume Report (Productivity Commission 2015) released late last year predictably recommended a range of so called industrial ‘reforms’, that if implemented, would send our system back to the dark days of WorkChoices.

For example, the recommendation that the Fair Work Commission (FWC) should, as part of its current award review process reduce the Sunday penalty rate to the Saturday penalty rate in the hospitality, entertainment, retail, restaurants and café (HERRC) industries (including fast food).

This recommendation is currently being considered by the FWC as part of an employer application to reduce penalty payments in several hospitality and retail sector Awards.

References Office of the Employment Advocate (OEA) data supplied to Senate Estimate Committee May 2006 Productivity Commission 2015, Workplace Relations Framework, Final Report, Canberra

While ‘essential services’ are not part of the Productivity Commission’s recommendation, there are no guarantees that this government, health industry employers, aged care employers or other employers of nurses, midwives and personal carers will not adopt this approach now or in the future. Government and employer arguments about the rising costs of health and aged care place increase pressure on maintaining accepted standards around wages and conditions of employment.

There are also many areas of employment in the health and aged care sector that are not as highly unionised or not covered by enterprise agreements and are more vulnerable

24 June 2016 Volume 23, No. 11

to a reduction or removal of penalty rates and allowances if it were not for the safety net of minimum standards set out in the relevant Awards.

Any reduction or removal of minimum conditions of employment in any industry should ring alarm bells for the rest of us. The rhetoric we hear too often from Coalition members and their supporters that regulation is ‘restrictive’ and workplaces ‘inflexible’, suggests they will not be satisfied until there is only the bare bones of regulation left in all sectors of the labour market.

FOR EXAMPLE, AN EMPLOYER COULD AGREE TO AN EMPLOYEE’S PREFERRED DAYS AND HOURS OF WORK ON THE CONDITION THAT THE PENALTY RATES OR SHIFT ALLOWANCES PAYABLE UNDER THE AWARD DO NOT APPLY.

This brings us to another recommendation of the Productivity Commission that is particularly alarming and could impact employees across all sectors of employment; that being the government amending the Fair Work Act to allow a new industrial arrangement called an ‘Enterprise Contract’. This is another version of the WorkChoices individual contract we knew as an ‘Australian Workplace Agreement’ (AWA) which allowed employers to offer individual contracts that sat outside the award system and contained wages and conditions that were below the minimum standards set down in awards.

The Australian public soundly rejected the harsh realities of the WorkChoices regime and AWAs back in 2007 however it appears the assurances by

Coalition members of Parliament that WorkChoices was ‘dead, buried and cremated’, refers to its title only.

‘Enterprise contracts’, as proposed by the Productivity Commission would allow an employer to offer new employees employment contracts on a take it or leave it basis, that is, sign up or no job, with no negotiation over the terms of the contract with employees or their union required.

Another worrying aspect of the proposal is that the ‘enterprise contract’ does not have to be approved by the FWC and any concerns that the wages and conditions do not meet the safety net is left to the individual employee to raise with the FWC. It is also possible under this arrangement for a contract to pass a ‘no disadvantage test’ on the basis of ‘non-cash’ benefits offered in the contract. For example, an employer could agree to an employee’s preferred days and hours of work on the condition that the penalty rates or shift allowances payable under the Award do not apply. In other words, employees may be asked to ‘trade-off’ award wages and conditions in return for working arrangements that are deemed ‘non-cash’ benefits.

It was evident under the system of AWA individual contracts, many employers took full advantage of the opportunity to reduce conditions using AWAs to remove or reduce a range of conditions including penalty rates, shift allowances, overtime payments, public holiday payments, leave loading and rest breaks (Office of the Employment Advocate, 2006).

There are few recommendations in the report that, if implemented, would not impact negatively on workplace laws, workplace rights and entitlements; reducing protections for employees and shifting the balance too far in favour of the employer.

The ANMF will campaign against any Coalition policy or plans to change the current industrial laws that will undermine employee rights and entitlements fundamental to maintaining fair and acceptable standards in all workplaces. anmf.org.au

Free time, family and no deadlines – the retirement we all want and can afford.

Super is one of the biggest investments most of us will make during our lifetime – what you do with your super today can really make a difference to your future.

Despite media claims you need $1million to retire, the majority of Australians live well in retirement by supplementing the Age Pension with their super.

HOW TO GET THE RETIREMENT YOU WANT WHAT HESTA MEMBERS say they WANT MOST

You can too.

For the majority of Australians the Age Pension is, and will continue to be, an important part of their income in retirement. Did you know, around 80% of Australians who’ve reached the age to qualify, receive a full or part Age Pension?*

“I want to do what I want, when I want.”

“I want to be able to catch up with family and friends.”

$1million in super not required.

While media stories can make us believe we need millions in retirement, if you’ve lived well on your current wage, living well in retirement is achievable – when you take simple steps to increase your super.

When combined with the Age Pension, even a modest super balance can help you enjoy the things you look forward to most – free time, no deadlines, fewer demands and less stress.

“I want to be off the clock.”

“I’d like to rediscover my hobbies and try new things.”

*Source: http://ncoa.gov.au/report/phase-one/part-b/7-1-age-pension.html

how you can make it happen

How to boost your super balance?

There are two options.

1. Contributions from your before-tax pay If you earn more than $50,000 p.a. this is usually the best way to build your super. The main benefit is tax – these contributions are generally taxed at 15% when they go into your super – so before-tax contributions make a lot of sense if you pay more than 15% income tax.

It’s also called ‘salary sacrifice’ – talk to your employer about setting up a regular contribution from your pay into your super account.

Keep in mind: •

Before-tax contributions may be subject to extra tax if you withdraw them from super before you turn 60.

•

They’re included in the income test for co-contributions and other government benefits.

•

Keep track of your super contributions, if you exceed your contributions cap, excess contributions may be taxed at your marginal tax rate, plus incur an interest charge.

Excess contributions can be withdrawn.

•

If you haven’t provided your TFN, contributions will be taxed at the highest marginal tax rate.

•

If your taxable income exceeds $300,000 your contributions will be taxed at 30%.

2. Contributions from your after-tax pay After-tax super contributions are paid from your take-home pay. If you earn under $50,000 p.a. this is usually the best way to build your super, because you could also receive a bonus super top up from the government.

You may have heard of the government co-contribution. This is where, for every dollar you put in to your super (from your after-tax pay) the government will kick in another 50 cents. It can be as much as $500 worth of bonus super from the government! It all depends on what you earn and how much you put in.

If an eligible HESTA member puts $1,000 extra into their super account each year – together with the government’s $500 co-contribution – here’s what can happen.^

Extra super at age 67

How much more? $119,820 more

From age 30

$70,416 more

From age 40

$36,515 more

From age 50

Of course, we’ve had to make some assumptions: Income $30,000 p.a. Account balance $0. Inflation 2.5% p.a. Growth rate after fees 6.5% p.a. (CPI+4%). Salary index 3.5% p.a. $1,000 non-concessional contribution made at end of each financial year from stated age to age 67 with $500 co-contribution received at the end of the following financial year, except the year member turns 67. Contributions received monthly, at end of each period, contributions tax applied at the time of contribution. Net growth rate on monthly contributions at 2.53%. Interest on concessional contribution based on interest calculated in 2014/15 financial year and applied as a constant rate of return each year thereafter. This is a conservative rate of return, actual interest applied will increase in line with salary indexation. Retirement at age 67. This example is an illustration only. It is not a guarantee in any way. Actual outcomes may vary.

It’s easy to set up regular payments into your super – using BPAY®, electronic funds transfer or direct deposit. For more information on the government co-contribution scheme visit ato.gov.au/super or hesta.com.au/contributions

How much can I contribute?

Each year, you can contribute up to $180,000 of after-tax earnings to your super. If you’re under 65, you can bring forward three years’ contributions into one year, to allow a maximum of $540,000.

Any contributions made over this amount will be taxed at the highest marginal tax rate.

Keep in mind: Your super fund needs your tax file number (TFN) or you can’t make after-tax super contributions.

HESTA offers members personal advice about which contribution strategy might be appropriate for them – at no extra cost. If you require advice about making contributions, you can speak to a HESTA Superannuation Adviser.

Call 1800 813 327 to make an appointment.

Growing your super comes down to what you put in and earning interest over time.

Fairer super for all HESTA is at the forefront of current political debate, examining why women retire with less than men.

We have been strongly advocating on behalf of our members at the Senate inquiry into the economic security of women in retirement. The inquiry has been examining why women retire with significantly less super than men and what changes could be made to improve the system.

The Senate inquiry’s report outlines 19 recommendations intended to help women increase their participation in the workforce and improve their super savings as a means of achieving dignity and economic security in retirement.

HESTA CEO Debby Blakey said it was encouraging that the multi-party Senate inquiry had focussed on reforms designed to improve the overall fairness of the super system.

“We welcome the report’s recommendations that focus on system-wide reform of super and tackling unequal pay,” Ms Blakey said.

“This is the most effective way to tackle long-standing equity issues in Australian society that result in women being far

more vulnerable to poverty later in life.

What we don’t want to see is another report like this sitting on a shelf gathering dust as this will simply expose future generations of women to the risk of an insecure retirement.”

HESTA’s submission stressed that the wage gap between men and women remains the biggest factor in women retiring with less than men.

“The gap in super savings that women experience is not due to the choices they make – the main causes are the gender pay gap that sees women earning less than their male counterparts and unpaid time out of the workforce.”

HESTA CEO, Debby Blakey

Closing the pay gap is clearly vital and must be tackled through structural and societal changes. In the meantime, the super system can also evolve. For many HESTA members, their super will supplement a retirement income that is underpinned by the Age Pension.

The vast majority of HESTA’s more than 800,000 members are women working in health and community services, where the gender pay gap is 27.7%, according to figures from the Workplace Gender Equality Agency.

“Super is there for every Australian and the conversation needs to start including low-income earners and women,” adds Debby.

It’s time

to take care of you!

Your health is your biggest asset, so make sure you are taking time out to nurture your body and soul.

You have probably thought about safeguarding the security of your assets, such as insuring your property from potential disaster. Yet when it comes to our biggest resource – our health – many of us drop the ball.

The reality is your ability to earn an income over a sustained period is your greatest financial asset, however, each year, many women have their ability to work cut short.

According to the Australian Bureau of Statistics (ABS), 21% of women are forced to retire early due to sickness, injury or disability.

One of the best ways to safeguard your physical and mental health is to actively invest in yourself by regularly making time for exercise and relaxation.

This isn’t always easy, particularly for women who maintain busy jobs and also have caring responsibilities for children or elderly parents at home. However, the benefits of adopting a few minutes of “me time” a couple of times a week, can have a dramatic effect on your overall health.

There are many ways to keep physically fit and mentally well, from attending yoga classes to enjoying a game of social tennis with your friends, walking the dog each morning or joining a netball team.

With regular exercise being linked to everything from weight reduction to improved cardiovascular function, superior quality of sleep and even improved life expectancy, there are a multitude of life-changing reasons to keep active.

At the core of the matter Weight training is a good option for women of all ages, says Manager of Melbourne’s Woodford Sports Science Consulting, Tiffany Toombs.

“A strong core is vital for health care workers to prevent injury,” Tiffany Toombs, Manager of Melbourne’s Woodford Sports Science Consulting She recommends anyone new to weight training finds a reputable personal trainer and starts with light weights. “Women will start to feel stronger and thinner within four weeks of starting a training program,” she says.

Lifting weights can also have mental health benefits.

“Weight training stimulates the release of endorphins and feel-good hormones, which helps decrease symptoms of anxiety and depression,” Tiffany explains.

Take time for yourself Making the time to unwind, be creative and keep our brains active should be on all of our agendas.

Whether you enjoy reading novels, doing jigsaw puzzles and crosswords, painting or knitting, setting aside the time to enjoy creative activities is one way to keep your brain active as you age.

You are your biggest asset, so invest in yourself to ensure good returns.

THREE WAYS TO INVEST IN YOUR HEALTH The best things in life are free. Here are three simple ways to invest in your health that don’t require any financial outlay:

1

2

3

Say “ohm”

Happy trails

Take a dip

As the pace of life accelerates, taking the time to slow down and cultivate stillness is crucial. The Australian School of Meditation & Yoga holds meditation classes all around Australia.

Many classes can be attended free or by donation.

Bushwalking is not only a free way to exercise, it’s also a good way to recharge away from city life. Time spent in nature has been linked to numerous health benefits, including lower blood pressure, so hit the trail or join a local bushwalking group.

Swimming uses most of the muscles in your body, works your core and is low impact, which is a great option if you have sustained an injury or are returning to exercise after a break. Just stick to patrolled beaches and stay between the flags.

asmy.org.au

bushwalkingaustralia.org.au

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HESTA CEO, Debby Blakey said this year’s winners exemplified the finest qualities of the nursing profession, and were leaders in their field.

A Perth nurse that developed a blood management program, a NSW team that launched an innovative Indigenous meal range and a graduate nurse that improved patient communication strategies all received top honours at the 2016 HESTA Australian Nursing Awards.

“These winners stood out from an exceptional group of finalists for being instrumental in leading innovation and improved practices that provide the highest quality care to patients, Ms Blakey said.

“We are proud to acknowledge the winners of this year’s nursing awards for the life-changing work they do, this is national recognition each of the winners richly deserves.”

HESTA CEO, Debby Blakey

2016 Award winners 2016 Nurse of the Year Angie Monk from Ramsay Health Care Angie was recognised for her leadership in developing an innovative Patient Blood Management Program that has improved outcomes and recovery for patients undergoing surgery involving significant blood loss.

2016 Outstanding Graduate Shelley Cook from Alfred Health Shelley demonstrated leadership in advocating for patient care and played a leading role in developing a staff training project aimed at raising awareness about communication strategies when working with culturally and linguistically diverse patients.

2016 Team Excellence Clinical Service Team from integratedliving Australia The clinical team were recognised for identifying an opportunity to fulfil a community need with an innovative approach to meals provision for Aboriginal people aimed at reducing the higher prevalence of negative health outcomes related to diet and nutrition.

The winners shared a $30,000 prize pool, generously provided by our longstanding Awards supporter ME, the bank for you.

Left to right, 2016 winners: Shelly Cook (Outstanding Graduate), Angie Monk (Nurse of the Year) and Bron McCrae representing the Clinical Service Team (Team Innovation).

Read their stories at hestaawards.com.au

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ETHICS

ACADEMIC DISHONESTY AND UNETHICAL BEHAVIOUR IN THE WORKPLACE Megan-Jane Johnstone

References Gaberson, K.B. 1997.

Academic dishonesty among nursing students.

Nursing Forum, 32(3): 14-20.

Hilbert, G.A. 1985.

Involvement of nursing students in unethical classroom and clinical behaviours. Journal of Professional Nursing, 1(4): 230-234.

Krueger, L. 2014.

Academic dishonesty among nursing students.

Journal of Nursing Education, 53(2):77-87.

Rujoiu O. & Rujoiu V. 2014. Academic dishonesty and workplace dishonesty: an overview.

Proceedings of the 8th International Management Conference: ‘Management challenges for sustainable development’, 6-7 November, Bucharest, Romania. Online: http:// conferinta.management. ase.ro/archives/2014/ pdf/91.pdf [accessed 20 April 2016]

Megan-Jane Johnstone is Professor of Nursing in the school of Nursing and Midwifery at Deakin University in Victoria.

Professor Johnstone has extensive interest and expertise in the area of Professional Ethics in Nursing. anmf.org.au

On 20 April 2015, the ABC’s Four Corners program aired ‘Degrees of deception’ (www.abc. net.au/4corners/stories/2015/04/20/4217741.htm) in which serious allegations of academic dishonesty in Australian universities were made. Notable among the allegations were ‘turning a blind eye to cheating’ and ‘turning out poorly trained graduates’ including ‘dangerously under qualified nurses’. Following this, on 5 November 2015, the SBS In Focus program broadcast ‘Pens for hire: How students cheat, and how they get away with it’.(www.sbs.com.au/news/thefeed/ article/2015/11/05/pens-hire-how-students-cheat-and-how-they-get-away-it).

In this program a confronting account was given of blatant ‘contract cheating’ whereby students would pay an impersonator to ghost-write essays, sit exams, and attend classes on their behalf – sometimes for an entire year and even an entire course. It is important to clarify that while these programs suggested the problem of academic dishonesty in Australian universities primarily involves international students, this is largely a myth. Local data suggests that the use of contract cheating services by domestic students is comparable to that of international students.

A question of nursing ethics

In light of the above, the question arises: Is academic dishonesty a significant moral issue for the nursing profession? The short answer is, yes.

In the cultural context of Australia there has been little attention given to the issue of academic dishonesty in nursing – what it is and why it is wrong. Also overlooked is the possible correlation between academic dishonesty (cheating in the classroom) and professional dishonesty (cheating in clinical settings) and its implications for the broader nursing profession.

Some suggest that the problem of academic dishonesty in nursing involves only a minority of students.

The reality is, however, that due to a lack of reliable data, the incidence and impact of academic dishonesty in nursing is not known.

Academic dishonesty

There is no consensus on what constitutes ‘academic dishonesty’ (also referred to as ‘academic fraud’).

Even so, it is generally accepted that academic dishonesty (a form of academic misconduct) fundamentally involves the ‘intentional participation in deceptive practices regarding one’s academic work or the work of another’ (Gaberson, 1997, p14). It can take several forms including plagiarism, cheating, altering records, falsifying records, forging academic documents, misrepresenting one’s skills, assisting another person in dishonest conduct,

fraudulently attributing/accepting co-authorship of publications, and intentionally impeding, misrepresenting or damaging the academic work of others (Gaberson, 1997; Krueger, 2014). It should be noted that academic dishonesty is not confined to students and can involve any person in an educational institution, including academic staff.

Academic dishonesty is a longstanding global issue, with some of the earliest studies on the problem dating back to the late 1920s. It occurs across a range of countries and disciplines, and in all levels of educational institutions (eg. primary, secondary and tertiary institutions) (Rujoiu & Rujoiu, 2014). A remarkable feature of academic dishonesty is its persistence and seeming resistance to being effectively counteracted.

Workplace dishonesty

Academic dishonesty has a particularly troubling implication for the nursing profession. There is growing evidence suggesting a positive correlation between academic dishonesty and professional dishonesty, with one US study also suggesting a positive correlation between permissive moral attitudes toward the ‘acceptability’ of cheating in the classroom and cheating in clinical settings (Krueger, 2014).

In this study, in which 336 nursing students were surveyed, over 50% of respondents admitted to cheating in both classroom and clinical settings. Cheating behaviours in the clinical setting included: ‘reporting and recording inaccurate and unobserved assessments, medication, and treatments’, ‘breaking sterile technique during procedures and not rectifying the error’, and performing procedures without a supervising clinical teacher being aware (Krueger, 2014, p82-83).

Threats to professional integrity

The nursing profession is highly regarded by the public. It is seen as being honourable and as one of

Australia’s most trusted professions.

In the interests of maintaining this reputation, the NMBA (2008) Code of professional conduct for nurses in Australia (2008) states unequivocally that all nurses have a stringent responsibility to ‘conduct themselves personally and professionally in a way that maintains public trust and confidence in the profession’ (www.nursingmidwiferyboard.gov. au/Codes-Guidelines-Statements/).

Academic dishonesty, by its very nature, contravenes the ethical standards of the profession, reveals a lack of conscience on the part of the offender and, as such, seriously threatens the good standing and reputation of nursing in the eyes of the public. This is because the incidence and impact of academic dishonesty undermines the fundamental values of honesty, trust, fairness, and responsibility – all of which are essential to the establishment and development of effective nurse-patient relationships, team work and patient safety.

The US-based International Center for Academic Integrity (ICAI) (www. academicintegrity.org/icai/home. php) invites faculty, administrators, students, trustees, and concerned alumni from across the globe to become involved in raising the level of academic integrity in university campuses. In extending this invitation the ICAI makes the important point that ‘When a society’s educational institutions are infused with integrity, they help create a stronger civic culture for society as a whole’. It would be both timely and appropriate for Australian university’s offering nursing courses and concerned nursing alumni to accept the ICAI’s invitation and co-participate in its Fundamental Values Project and associated activities. This will help not only to create a stronger civic culture in society, but also in the nursing profession. Meanwhile, more nursingfocused research on this issue is required to enable an evidence-based response to remedying the problem.

June 2016 Volume 23, No. 11 33

CLINICAL UPDATE

WHEN WORDS FAIL A SUMMARY OF APHASIA: INCORPORATING BACKGROUND MEMOIR ACCOUNTS. Jenny Esots A large number of clients, who suffer a cerebral vascular accident (CVA), commonly known as a stroke, require long-term rehabilitation.

The cause of a stroke can be divided into two categories, ischaemic and embolic.

The term stroke is widely used which comes from antiquity, when medical knowledge was rudimentary. It was used to describe the way someone in seemingly good health could suddenly develop loss of function of some part or parts of their body, or even suddenly die.

It was assumed that they had been ‘struck down’ by God; hence, they had suffered a stroke (Souter, 2013).

Following a stroke the patient will have a variety of conditions depending on the area and severity of the brain affected. One of the most troubling effects of a stroke is the condition of aphasia, which can have quite lasting consequences for recovery and communication in those affected.

In researching the condition of aphasia there are many personal accounts published in the form of a memoir that highlight how challenging the rehabilitation process is for the client and carer alike. Grounded and honest accounts show the very real struggles associated with aphasia.

34 June 2016 Volume 23, No. 11

anmf.org.au

CLINICAL UPDATE An hour ago he was awake and seeking Them – words, those skiddy fish Of the self, schooled in between Seeing. He is looking, for nets, for bait For the slippery hooks of our need To be in the world in particular clothing He is trying, you can see he is trying For what we haul in each day Without thinking: the slithering masses Of sound that are our names for this, for that, For everything that matters (Brett, 2014 page 206)

where to place his tongue, which of his muscles to move and in what sequence and how to coordinate all of these movements with his breath in order to make just one specific sound.

As almost all words consist of multiple sounds, even one syllable words such as ‘yes’, the mechanics of speaking even one word, let alone a sentence, require sustained concentration and intense learning. His brain has simply lost the connections that tell it how to do this automatically.’

(Brett, 2014 page 64)

Definition

Signs and symptoms of aphasia can be divided into four main areas of impairments, verbal expression, auditory expression, reading comprehension and written language impairments.

Aphasia is defined as ‘a loss of ability to produce or understand language’ (Clark, 2014). Aphasia is a significant problem in recovery from stroke.

Just under one third of patients have aphasia. Significant quantities of patients will have difficulties with speaking, listening, reading and writing, with other problems associated with gestures. Aphasia is distinct from related disorders as Kirshner (2004) states “aphasia is distinguished from congenital or developmental language disorders, called dysphasias. Aphasia is a disorder of language rather than speech. Speech is the articulation and phonation of language sounds; language is a complex system of communication symbols and rules for their use’’.

It is important to distinguish disorders of thought from aphasia. “Aphasia is distinguished from disorders of thought. Thought involves mental processing of images, memories and perceptions, usually not involving language symbols. Psychiatric disorders derange thought and later content of speech without affecting linguistic structure” (Kirshner, 2004).

The left side of the brain plays the primary role in processing language.

Almost everyone with aphasia has left sided hemiplegia.

Doris Brett describes in her memoir, The Twelfth Raven, the slow, frustrating and all-consuming process of supporting her husband Martin following his stroke. She is able to articulate the experience and painstaking process of learning to speak and process words again.

The author, a psychologist, is used to analysing thoughts, feelings and behaviours. The Twelfth Raven refers to a rhyme where the twelfth refers to joy for tomorrow.

‘He is now for the first time, started to be able to shape certain sounds.

Whereas we make these sounds without thinking, Martin has to learn what shape to curve his lips into, anmf.org.au

The prognosis for aphasia recovery depends on the underlying etiology. Most people make some improvement over time. Clark (2014) reports most improvement occurs within the first few months and plateaus after one year. The severity of the initial aphasia strongly correlates with long-term deficit; those with milder degrees of aphasia at onset are most likely to recover completely.

Signs and symptoms of aphasia

Clark suggests diffusion and perfusion resonance imaging (MRI) studies demonstrate that early recovery after stroke (in the first few days and weeks) is related to reperfusion of language areas.

Expressive aphasia – when the individual knows what they want to say or write, but has difficulty with speech. This arises when Broca’s area is affected and is sometimes known as Broca’s aphasia.

Other factors that may influence prognosis are still being researched.

Clark states while there is some evidence to suggest that left handed individuals with left hemisphere stroke and women have less complete lateralisation of language dominance than right handed individuals and men, neither handedness nor gender have consistently been shown to impact recovery from post stroke aphasia. Similarly, increased age has not been shown to influence prognosis (Clark, 2014).

Receptive aphasia – when the individual can hear the voice of another person, but cannot interpret or understand it. Their speech may retain its fluency, but some of the words may be nonsensical and sentences may have mistakes in them.

This arises when Wernicke’s area is affected and is sometimes known as Wernicke’s aphasia.

Anomic aphasia – when the individual has difficulty in finding words or names. Many people have this problem, called anomia, but a stroke makes it worse and more distressing.

Global aphasia – this occurs when both speech and the understanding of words is lost. The ability to read and write may also be lost. It is usually as a result of a larger stroke affecting both Broca’s and Wernicke’s areas (Souter, 2013).

‘Martin’s speech now has several words that can be made out clearly and he is better able to write down the word he is trying to say’ (Brett, 2014 Page 81).

Prognosis and recovery

The prognosis of aphasia is highly variable. It is dependent on factors such as the location of the lesion in the brain and the type of aphasia. It is acknowledged that large lesions in the left hemisphere with global aphasia have a much poorer recovery than small, subcortical lesions with anomia (Clark, 2014).

This morning I am sitting in on another of Martin’s speech therapy sessions.

Today the therapist is trying to teach Martin how to form the sound ‘p’.

Martin’s brain is completely at a loss to do this – it has not the first notion of what instructions to give the muscles of mouth and tongue. The speech therapist is helping Martin by showing him the shape her lips form as she pronounces the sound ‘p’ and how she expels her breath at the same time. Martin looks closely and you can see him straining, really straining as he attempts to reproduce the sound.

‘Great!’ says the therapist. ‘Now do it again’.

And so they do it again and again.

Each time you can see how much work it requires of Martin. This simple miniscule task, so effortless and trivial that it is effectively invisible in our day-to-day interactions, is the equivalent of running a triathlon for Martin’s new brain. But he persists and gradually I can see it is getting just slightly, slightly easier (Brett, 2014 page 82).

Clinical investigations in the aphasic person The most definitive diagnosis of aphasia is made by neuroimaging.

The CT brain scan has made diagnosis a lot more accurate.

CT brain scan revolutionised the

References Brett, D. 2014, The Twelfth Raven: A Memoir of Stroke, Love and Recovery, University of Western Australia Publishing, New South Wales.

Clark, D.G. Aphasia: Prognosis and treatment. In: UpToDate, Mendez, MF & Wilterdink (Ed), UpToDate, 2014.

Kirshner, H.S. 2004, ‘Language and Speech Disorders’, in WG Bradley, RB Daroff, GM Fenichel & J Jankovic (eds), Neurology in Clinical Practice: Principles of diagnosis and management, Butterworth– Heinemann, Philadelphia, pp.

141-164.

LaPointe, LL 2011, Aphasia and Related Neurological Language Disorders, 4th edn, Thieme Medical Publishers, New York.

Souter, K. 2013, Understanding and Dealing With Stroke, Summersdale Publishers Ltd, United Kingdom.

Unklesbay, N. 2010, Swimming Against the Tide: Strong Recovery From Stroke, AKAPublishing, Missouri.

June 2016 Volume 23, No. 11 35

CLINICAL UPDATE localisation of aphasia by permitting ‘real time’ delineation of a focal lesion in a living patient; previously, the physician had to outlive the patient to obtain a clinical pathological correlation at autopsy. MRI provides better resolution of areas difficult to see on CT images. The EEG is helpful in aphasia in localising seizure discharges, interictal spikes and slowing seen after destructive lesions such as traumatic contusions and infarctions (Kirshner, 2004).

Other investigations include cerebral arteriography which is useful in diagnosis of aneurysms, arteriovenous malformations (AVM’s), arterial occlusions, vasculitis, and venous outflow obstructions (Kirshner, 2004).

Recovery and rehabilitation of the person with aphasia

The road to recovery for those affected by aphasia is difficult and varied. While some patients grab opportunities with all their strength, others are resentful and angry or withdrawn and depressed. Progress can be grudgingly slow or remarkably quick. A multidisciplinary team approach enables timely assessment of the pathophysiological condition, incorporating the mental, physical, emotional and spiritual wellbeing of the person. Treatment is always individually tailored. The recovery process and timeline is often varied, generally slow spontaneous improvement over days, weeks, and months. In general, the fastest recovery occurs in the first three months, but improvement may continue over a prolonged period (Kirshner, 2004).

Martin continues to work assiduously on his speech. His speech therapy sessions take up an hour or so each day, but in between he has speech homework – pages of word-matching puzzles, sentence completion tasks and the like. He can write a greater number of words, and his spoken vocabulary is growing each day – he can now put a few words together into phrases.

The effort he uses to pronounce these words is clear. Each word is spoken with care and slow precision of a non-native speaker who is learning English from a spoken-word disc. The spoken word disc Martin has in his head is narrated by an educated Englishman. It is not Martin’s natural accent. (Page 87)

Speech therapy

Speech therapy is a main line of treatment; speech therapists attempt to facilitate language recovery in which a variety of techniques are used. One of the main practices involves repeated practice in 36 June 2016 Volume 23, No. 11

articulation and comprehension.

Writers repeatedly reference the painstaking and slow process of regaining speech with the aid of speech therapists.

In her memoir entitled Swimming against the Tide, Nan Unklesbay describes her experience with therapy in rehabilitation as: Fortunately your brain can relearn what it has lost. I struggled. I lost my temper with Ken when he said ‘That is so simple even children can do it’. I rarely lose my temper, so this was quite a different experience.’

(Unklesbay, 2010 page 88) A speech therapist is an essential and integral part of the rehabilitation team. A thorough assessment is required on admission. A speech therapist is likely to see the patient soon after admission, in order to do a swallowing assessment. The speech therapist will also make an assessment of the patient’s ability to understand and communicate (Souter, 2013).

Other therapeutic techniques include melodic intonation therapy, which uses melody to involve the right hemisphere in speech production; visual action therapy, which uses gestural expression; and treatment of and preservation, which aims to reduce repetitive utterances (Kirshner, 2004).

The practice of speech therapy involves ongoing research into its effectiveness. The body of evidence on the prospect of beneficial outcomes obtained through the treatments of speech-language pathologists is not unanimous. In part, the equivocation may be attributed to less than optimal experimental designs reported in some papers and the negative or indeterminate outcomes of those studies (La Pointe, 2011).

Kirshner concurs, the available data from clinical trials offer weak support for this approach (speech and language therapy), but no single technique has emerged as more effective than others. The use of speech and language therapy has become standard of care and has value in helping patients and families compensate for the devastating loss in the patient’s communication skills (Kirshner, 2004).

It is not only the accent that has changed. Something else has changed. Writers commonly talk of finding the ‘voice’ of their characters.

They mean not only the words the characters utter but the tone in which they are spoken: the ways these words which lie silent on the page, take on a timbre, an intonation that colours

in for us the character of the speaker.

The unquantifiable yet definite character of Martin’s speech has changed, as well as his accent. There is a flatness to his speech, which is technically termed ‘robotic’, and it does indeed have the characteristics of robotic recorded responses in which each word is equally accented without the natural lift and fall of our normal speaking voices. But equally striking is a quality almost the opposite to that of a robot. It is the quality of a child learning to speak (Brett, 2014 Page 88).

Kirshner (2004) acknowledges that speech therapy has remained controversial. Some studies suggest briefly trained volunteers can induce as much improvement as that achieved by speech/language pathologists, but large randomised trials have clearly indicated that patients who undergo formal speech therapy recover better than untreated patients.

Part of what Martin is now working on in his speech therapy sessions is getting back his normal voice and intonation. His speech therapist is getting him to say the same sentence several times, using a variety of emotional tones (angry, happy, pleading, and so on). This is working well – Martin’s voice and accent are markedly more melodic as he does this. And of course it appeals to the thespian in him –Martin is an excellent natural actor (Brett, 2014 page 144).

Conclusion

Aphasia is a common complication of stroke and can cause significant disability. It is a condition that many patients and carers struggle to cope with, as communication forms such a vital part of our existence. Some improvement occurs initially and prognosis is dependent on many factors, critically the size and area of the brain affected.

Speech therapy is the mainline of treatment, although there are varying accounts of its effectiveness in peer reviewed research and randomised controlled trials.

A multidisciplinary team that engages patient and carer in the recovery process is vital. It is certainly not compulsory to document this recovery process in a memoir. But firsthand accounts of recovery give valuable insight into the challenging condition of aphasia.

Martin is wonderfully well – doing all the things he loves, speaking with his new accent and displaying more energy and stamina than I possess.

(Brett, 2014, page 294)

Jenny Esots RN, BA Nursing, Grad Dip Mental Health Nursing anmf.org.au

REFLECTION …THROUGH WRITING THIS ARTICLE, MORE PEOPLE WILL CONSIDER PLACING THEMSELVES ON THE BONE MARROW REGISTER or panadeine. I normally have a good pain threshold. Perhaps I’m feeling like this because I’m a bit nervous, or maybe my body is just a bit more sensitive to the injections?

RASA KABAILA

I’ve still been exercising, but the pace and intensity of how I have been doing things for the last few days has certainly decreased.

Either way, this is absolutely nothing compared to side effects that people experience from cancer treatments, which puts everything back into perspective.

Day of procedure:

DONATING TO SAVE OTHERS

By Rasa Kabaila Over a year ago I placed my name on the bone marrow register but was told, ‘don’t ever expect to be picked as it’s nearly impossible to be a tissue match for someone needing a transplant’. Yet six months later I was contacted by the Bone Marrow Transplant Centre and was asked if I was available to donate, to which I said yes. This is my firsthand account of being a stem cell donor. A month before stem cell donation I’m being flown to Sydney with my brother as my companion carer for a full day of medical testing.

From arriving, after the 7:20am flight, my day is taken up by a series of blood tests, an ECG, chest xray, examination by the doctor and a counselling session. I am also given instructions on how to take growth hormone injections prior to the procedure and then there is more debriefing with one of the donor coordinators over lunch.

I ask the cancer nurse why people think that the bone marrow transplant is so aggressive and if it used to be a difficult procedure in the past. The anmf.org.au

cancer nurse assures me that the procedure has always been safe and straightforward rather than something gruelling.

I meet with the bone marrow coordinator, and ask how likely it is to find a bone marrow tissue match for someone needing a transplant. She says that if everyone in Australia had no choice but to be on the register, the recipient in need would have a one in 40,000 chance of finding their tissue match. But as it stands, with the amount of people who are registered, people needing a transplant have one in a million chance of finding their match.

The night before the procedure I’m now preparing for the big day tomorrow. Tonight my sister and I fly to Sydney. At 8:15am tomorrow I’ll have needles in my arms and will be going through the stem cell donation procedure.

I have one more lot of growth hormone injections to take tonight with an extra batch ready to go tomorrow if needed. This is day four of the injections. It’s been a bit of an out of body experience, my energy levels switch between being overactive, really tired and then spaced out. I knew to anticipate bone pain; at times it feels like an acute stabbing or radiating pain and at other times, more of an achy flu like feeling. I’ve asked for panadeine fort as it was getting a bit hard to manage.

The nurses inform me that most people manage the pain with panadol

I’m sitting here in the hotel room post procedure. The stem cell donation was a success. Apparently my stem cell count was huge (this is a good thing) which explains why I’ve had a lot of pain. I won’t need to take any more growth hormone injections or need to go in for a bone marrow harvest tomorrow. I’ll continue to have joint pain for a few more days and that will be the end of it.

The hardest thing during the procedure was not being able to move my arms. My sister, volunteers and nurses were kind to me and fed me food and gave me water. They also taped together a few straws so I was able to scratch my face.

The procedure really did feel just like a plasma donation, with both arms being used, nothing too out of the ordinary. As the procedure was finishing, I could hear an elderly man vomiting as a result of his cancer treatment. This really made me appreciate that feeling ill for a few days in order to do a stem cell transplant is really nothing compared to what people are going through when they need a donation.

This has been a once in a lifetime experience, and a very positive one. I hope that through writing this article, more people will consider placing themselves on the bone marrow register. As a previous donor once said, ‘Who knows, maybe one day you will need this.’

For more information about how to be on the bone marrow register list go to: www.abmdr.org.au/ or call: 02 9234 2405

Rasa Kabaila is a Registered Nurse Level 3 from the ACT This article is based on the views and research of the author(s) and has not been peer reviewed.

June 2016 Volume 23, No. 11 37

ISSUES

PREVALENCE, DISTRIBUTION AND IMPACT

By Patricia Schwerdtle Type 2 diabetes is the world’s fastest growing chronic condition and a serious concern for global health. The number of people with Type 2 diabetes is increasing in every country of the world. In 2015, it was estimated that one in 11 adults had diabetes worldwide (415 million people) and that by 2040, one in 10 people will have diabetes (642 million people), (Diabetes Australia, 2015).

Although diabetes was previously seen as a disease of affluence, three out of four people with diabetes now live in low and middle income countries (LMCs), also known as developing countries.

Globalisation, nutrition transition, urbanisation and increasingly sedentary lifestyles have contributed to the global epidemic of diabetes.

The increasing proportion of older people globally is contributing to an increase in age-associated chronic disease, especially in developing countries (WHO, 2015).

Chronic diseases like diabetes have overtaken the prevalence of communicable diseases worldwide.

The burden of diabetes is also heavier in low resource settings because the major sufferers are relatively young, of lower socioeconomic status and suffer from a more severe and premature onset of the disease (Allender et al.

2008).

Currently, 12% of the global health expenditure is spent on diabetes ($953 billion AUD). In 2040, this expenditure will exceed $1,136 billion AUD (Diabetes Australia, 2015).

Diabetes, like many other chronic diseases, are poverty catalysts and have serious implications for development. In countries without universal access to healthcare, the medication reliance and chronic progressive nature of the illness can be financially devastating to families (IDF, 2015).

The social determinants of Health

The social determinants of health are the economic, social and political systems that shape conditions of daily life and recognised to be the underlying causes of ill health (WHO, 2015). For diabetes they include factors best addressed at a policy level, rather than an individual level and include food, activity, employment, education and social equity.

The underlying determinants of diabetes are subtle, complex and interacting so they are often 38 June 2016 Volume 23, No. 11

overlooked and under-prioritised by policy makers and funding bodies.

Addressing them also requires intersectoral action, integrated strategies and time to measure impact, which is not as easily demonstrated as curative interventions and chronic disease management. However, as the Lancet Commission demonstrated addressing the underlying SDH is a key strategy that will lead to sustainable and affordable solutions to the increasing burden of chronic diseases like diabetes worldwide (Marmot, 2005).

NURSES REALISE THAT REDUCING THE RISK OF DIABETES IS NOT JUST ABOUT EDUCATION AND BEHAVIOUR CHANGE, BUT ALSO ABOUT ADDRESSING THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH

Nurses realise that reducing the risk of diabetes is not just about education and behaviour change, but also about addressing the underlying social determinants of health. Strategies will be more effective using advocacy and empowerment to ensure the places in which people live and work enable them to be healthy.

Nurses role in global health

In an increasingly connected world, global health is more frequently appearing on the local agenda. An investigation into the role of nurses in global health revealed four key areas for action: Policy, Advocacy, Research and Education. Nurses can lobby for policies that promote public health. They can also advocate for safe, affordable healthy food and environments that ensure the healthy choice is the easy one. There are

numerous examples of nurse-led research in global health particularly in the area of promoting health and preventing and managing chronic diseases like diabetes (NINR, 2015).

Finally, nurses and midwives are wellpositioned in their daily practice to provide health education, encourage healthy behaviours and ease access to primary and secondary prevention of diabetes (WHO, 2015).

Nurses in Australia may ask what they can do to address such a vast problem as diabetes in global health.

Firstly, an awareness of the scale and complexity of the issue is critical.

Furthermore, through working in healthcare in every context nurses are increasingly caring for the world, as population movement and diversity increases exponentially.

Considering the high number of undiagnosed people with diabetes, nurses play a key role in recognising the risk factors and early signs and initiating or referring to screening.

Early diagnosis leads to better outcomes and fewer long term complications such as kidney failure, blindness and amputation (IDF, 2015).

As the world population expands, moves and diversifies and as disease patterns change, so must our views and practice as healthcare professionals.

The prevalence of diabetes is increasing in all countries due to globalisation, urbanisation and the ageing population worldwide. A disproportionate amount of this load is carried by developing countries.

Addressing the social determinants of health is key to reduce the huge social and economic impact of the global diabetes epidemic. Nurses are uniquely placed to engage in policy, advocacy, research and education and the key to success is collaboration across disciplines and borders.

Patricia Schwerdtle is a Lecturer, Nursing and Midwifery at Monash University This artilce is based on the views and research of the author and has not been peer reviewed.

References Allender S, Foster C, Hutchison L, Arambepola C (2008) ‘Quantification of Urbanization in relation to chronic diseases in developing countries: A Systematic Review’.

Link: www.ncbi. nlm.nih.gov/pmc/ articles/PMC2587653/ pdf/11524_2008_ Article_9325.pdf Diabetes Australia (2015) ‘Diabetes Globally’, Diabetes Australia. Link: https:// www.diabetesaustralia. com.au/diabetesglobally International Diabetes Federation (2015) ‘Diabetes: A global health and development challenge. Link: www. idf.org/publications/ diabetes-global-healthand-developmentchallenge Marmot M (2005) ‘Social determinants of health inequalities’, The Lancet, Vol. 365 Issue 9464. P. 1099 - 1104 National Institute of Nursing Research (2015) ‘Overview of Global Health Research’, National Institute of Nursing Research.

Link: www.ninr.nih.gov/ researchandfunding/ globalhealth#.

VsvR7lt97RY WHO (2015) ‘Social determinants of Health’, World Health Organization. Link: www.who.int/social_ determinants/en/ WHO (2015) ‘Noncommunicable disease fact sheet’, Link: www.who.int/ mediacentre/factsheets/ fs355/en/ WHO (2015) ‘Diabetes fact sheet’, Link: www. who.int/mediacentre/ factsheets/fs312/en/ Wood D, Etter R (2010) ‘A global profession’, John Hopkins Nursing Magazine, Link: www. magazine.nursing.jhu. edu/2010/08/a-globalprofession/

anmf.org.au

RESEARCH

PEPPERMINT INHALERS – THE NEW ANTIEMETIC

DRUG TRIAL AIMING TO SLOW ALZHEIMER’S

A peppermint inhaler to relieve post-op nausea has been developed by US nurse researchers.

The University of Melbourne is calling on Victorians to be part of the world’s largest drug trial aimed at delaying the onset of Alzheimer’s disease.

Two Cardiovascular Critical Care Unit nurses at Christiana Care Health System in Delaware who developed the inhalers presented their findings at the recent American Association of Critical Care Nurses National Teaching Institute & Critical Care Exposition in New Orleans in May.

More than 400 healthy adults aged 65 to 85 who do not have any memory problems are needed to undertake the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s Disease study.

“What we realised was there was this strong body of knowledge out there that suggest that peppermint is an effective anti-nausea agent,” Nursing Research Facilitator Lynn Bayne said.

Participants will undergo a simple and painless brain scan, then researchers from the University of Melbourne and Florey Institute of Neuroscience and Mental Health will examine the scans for a build-up of amyloid plaques, which can lead to Alzheimer’s disease.

The inhalers are predominantly for use in pregnant women, patients waking from anaesthesia, those undergoing joint replacements and people with colitis.

Eligible participants who show high levels of amyloid will either receive a monthly dose of a promising new antiamyloid drug, or a placebo.

If the inhaler is going to be effective, it works in two minutes, according to the researchers. If not, a patient can be treated with a pharmaceutical anti-emetic.

Professor Colin Masters, who will lead the study, said researchers hope one of the new anti-amyloid drugs will halt early damage to the brain as a result of Alzheimer’s disease.

The peppermint inhalers are less expensive than pharmaceutical options and have no known side effects; and can be used by patients of any age and as often as patients need.

“This study is about predicting who is at risk and how fast they will decline,” Professor Masters said.

A total of 93% of study participants reported satisfaction with the inhaler’s effectiveness and said they would use it again.

“Just giving them the inhaler made patients feel they had more control over their care, and it was easy for nurses to incorporate into their routine,” nurse developer and researcher Helen Hawrylack said.

“This is the first attempt at stopping the disease before it starts and before it progresses to full-blown dementia.”

Recruitment for the study will close at the end of 2016 and initial results are expected by 2020.

To find out more or enrol in the study call 1800 443 253 or visit www.florey.edu.au Australians living with dementia

“The ultimate goal is for it being a firstline therapy that you would offer to a patient.”

NOW

2050

The study will be published in the June edition of Journal Nursing 2016.

353,800

900,000

THERE IS MORE THAN 353,800 AUSTRALIANS LIVING WITH DEMENTIA AND WITHOUT A MEDICAL BREAKTHROUGH THE NUMBER OF PEOPLE WITH DEMENTIA IS EXPECTED TO RISE TO 900,000 BY 2050

anmf.org.au

INDIGENOUS HEALTH ORGANISATIONS TREATING MORE Federally funded primary healthcare organisations charged with providing healthcare to Indigenous Australians treated 435,000 people, encompassing more than 3.5 million episodes of care, during 2014-15, new data released by the Australian Institute of Health and Welfare (AIHW) shows.

The report, Aboriginal and Torres Strait Islander health organisations: Online services report-key results 2014-15 sourced information from 278 organisations across Australia providing healthcare to Aboriginal and Torres Strait Islander people.

About 73% of these organisations provided primary healthcare services and 68% were Aboriginal Community Controlled Health Organisations. Services included clinical care, health promotion, child and maternal health, social and emotional wellbeing support, and substance use prevention.

Compared with 2013-14, the number of client contacts rose by 9%, while the number of individual client numbers increased by 4%.

The upward trend is evident annually, with the number of contacts per client each year increasing from 7.7% in 2008-09 to 11.6% in 2014-15.

In 2014-15, most organisations provided maternal and child health services, with 7,400 Indigenous women accessing antenatal services through 34,100 visits. Around 22,100 health checks for Indigenous children aged 0-4 were conducted.

Social and emotional wellbeing services such as counselling, and including family tracing and reunion support, was provided by 97 organisations employing 221 counsellors, a 17% increase compared with 2013-14.

Substance use services were offered at 67 organisations and saw 25,200 clients through 151,000 episodes of care, an average of six episodes of care per client .

Across the board, there were 4,454 health staff employed in Indigenous ‘primary healthcare’ organisations and just over half (53%) identified as Indigenous. The most common health workers were nurses and midwives (15%) followed by Aboriginal health workers (11%) and doctors (6%).

Client contacts by nurses and midwives represented half of all client contacts in remote areas compared with 29% annually.

June 2016 Volume 23, No. 11 39

MENTAL HEALTH Part 2

PHYSICAL HEALTH PROJECT: A MENTAL HEALTH NURSING LED INITIATIVE

By Nicole Butterfield The physical health of mental health consumers is of significant concern with research indicating they have higher rates of physical health related mortality and morbidity and 10-20 years shorter lifespan than the general population (Muir-Cochrane, 2008).

In 2013 the Trevor Parry Centre, a Community Rehabilitation Centre and part of the Southern Adelaide Local Health Network’s Mental Health Service, developed the nurse led Physical Health Project to address this significant issue for mental health consumers.

The Physical Health Project was developed in consultation with Trevor Parry Centre staff and consumers, Southern Mental Health Services and the Nurse Practitioner Candidate.

A physical health committee was developed with multidisciplinary staff, audits undertaken, clinic processes trialled and staff and consumer education sessions held. The Physical Health Open Day held in February 2014 marked the opening of the clinic and has now become an annual event.

The aim of the Physical Health Project was to run a monthly appointment based Physical Health Clinic; implement a Lifestyle Star Assessment 40 June 2016 Volume 23, No. 11

tool, link consumers to community fitness groups, support consumers to develop goals related to their physical and mental health, identify at risk consumers, provide recommendations and develop a local metabolic referrals pathways.

Outcomes have been positive with all consumers now having a monthly physical health screen, linked to a general practitioner and having a physical healthcare plan. Consumers’ self-rating of their diet and exercise, knowledge of their physical health and participation in fitness groups also improved. Today the clinic continues to thrive with plans to link with exercise physiology student placements and chronic conditions self-management projects.

The Physical Health Project has helped break down barriers to engaging with consumers about their physical health, encouraged multidisciplinary team cohesion and facilitated share-care arrangements

OUTCOMES HAVE BEEN POSITIVE WITH ALL CONSUMERS NOW HAVING A MONTHLY PHYSICAL HEALTH SCREEN, LINKED TO A GENERAL PRACTITIONER AND HAVE A PHYSICAL HEALTHCARE PLAN

with general practitioners. This nurse led initiative also provides a model for clinical practice in other settings and promotes the importance of mental health nurses in leading change and implementing practice improvements with a focus on holistic consumer centred care.

Reference Muir-Cochrane, E. 2008 An exploration of issues in the management, Advances in Schizophrenia and Clinical Psychiatry, vol 3 (4), 114-123.

Nicole Butterfield is Associate Clinical Service Coordinator – Trevor Parry Centre; PhD Candidate – University of Adelaide anmf.org.au

Part 2 MENTAL HEALTH

THE SAFEWARDS PROGRAM IN QUEENSLAND PUBLIC HOSPITAL ACUTE MENTAL HEALTH SETTINGS NIALL HIGGINS

By Niall Higgins, Nathan Dart, Thomas Meehan, Paul Fulbrook, Michael Kilshaw, Debra Anderson and Lisa Fawcett Aggression during psychiatric hospitalisation is frequent, problematic, and a major challenge for nurses and mental health services more generally. An important protective factor that can limit the likelihood of aggression is the strength of the therapeutic alliance between nursing staff and consumers.

The continuing need to focus on good communication and teamwork are also integral to contemporary management of aggressive behaviour (Emmerson et al. 2007). The Safewards program, designed by Professor Len Bowers, Kings College London, offers the opportunity to reduce the frequency of these risks and harmful events resulting with keeping consumers and staff safer (Bowers et al. 2015). This is obtained by reducing the conflict originating factors and finding alternative ways to manage them to prevent flashpoints from arising.

The aim of the research at Metro North Mental Health in Queensland was to introduce the structured Safewards program of 10 mental health nursing interventions in order to understand their impact compared with the traditional approach of nursing assessment and management of aggression. Ethics approval was granted to conduct the current study on general inpatient psychiatric wards of RBWH, TPCH and Ipswich Hospitals. Safewards has not previously been studied in specialised units and we are currently extending this to Secure Mental Health Rehabilitation Units.

References Bowers, L., James, K., Quirk, A., Simpson, A., Stewart, D. and Hodsoll, J. 2015 Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial. International Journal of Nursing Studies, 52 (9), 1412-22.

Available online at www.sciencedirect. com/science/article/pii/ S0020748915001601 Emmerson, B., Fawcett, L., Ward, W., Catts, S., Ng, A. and Frost, A. 2007 Contemporary management of aggression in an inner city mental health service, Australasian Psychiatry, 15 (2), 115-8

anmf.org.au

The 10 interventions were implemented over a six month period between October 2015 and March 2016. The evaluation has three recognised components, process, impact and outcome.

Throughout the project, data has been collected on the number of staff receiving education support; hours of supervision provided at unit level to support the program; number of components of the program successfully implemented; and staff feedback on implementation issues and program usefulness. Impact measures completed at six months are currently being compared with baseline and they will be compared again at 12 months to see if there is maintenance of effect. The outcome

evaluation focussed on how the implementation has impacted on conflict and containment indicators.

The overall evaluation has been carried out by the Royal Brisbane and Women’s Hospital mental health nursing academic office in collaboration with Service Evaluation Unit at The Park – Centre for Mental Health, Treatment, Research and Education and Queensland University of Technology, School of Nursing.

Niall Higgins is at the Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Brisbane and the University of Technology, Brisbane Nathan Dart and Lisa Fawcett are both at the Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Brisbane and the Australian Catholic University, Brisbane Thomas Meehan is at The Park – Centre for Mental Health, Treatment, Research and Education, West Moreton Hospital and Health Service, Brisbane and the University of Queensland

THE AIM OF THE RESEARCH AT METRO NORTH MENTAL HEALTH IN QUEENSLAND WAS TO INTRODUCE THE STRUCTURED SAFEWARDS PROGRAM OF 10 MENTAL HEALTH NURSING INTERVENTIONS IN ORDER TO UNDERSTAND THEIR IMPACT COMPARED WITH THE TRADITIONAL APPROACH OF NURSING ASSESSMENT AND MANAGEMENT OF AGGRESSION

Paul Fulbrook and Michael Kilshaw are both at The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane and the Australian Catholic University, Brisbane Debra Anderson is at the Queensland University of Technology, Brisbane

June 2016 Volume 23, No. 11 41

Anti-Poverty Week 16-22 October 2016 For more ideas and information, visit www.antipovertyweek.org.au email apw@antipovertyweek.org.au call 1300 797 290

This is a week when we can all do something about poverty

WHAT HAPPENS NEXT IS UP TO YOU MedicAlert® can mean the difference between life and death.

Don’t forget to check for a MedicAlert medical ID during patient assessment.

Check

around your patients’ wrists or neck for the genuine MedicAlert emblem. If conscious, ask your patient if they are a MedicAlert member.

Read

the medical and personal information engraved on the reverse of the patient’s MedicAlert medical ID.

Call

the 24/7 emergency hotline number engraved on the medical ID (08 8272 8822) to receive further medical and personal information.

medicalert.org.au/nurses

Advise

on handover that your patient is wearing a MedicAlert medical ID.

Part 2 MENTAL HEALTH

MEETING THE MENTAL HEALTH NEEDS OF RDNS CLIENTS

RDNS MENTAL HEALTH CLINICAL NURSE CONSULTANT BARBARA WILLIAMS (RIGHT) ON THE ROAD WITH COLLEAGUE VIRGINIA ABELA RN

By Barbara Williams In 2005 I began work on a project titled RDNS Model of Mental Healthcare looking at the mental health needs of RDNS clients. It was established that there was a significant need for assistance and education for both clients and staff and this led to the development of the role of Mental Health Clinical Nurse Consultant.

I have worked in this role for the past 10 years, initially in specific pockets of Melbourne and now right across the length and breadth of the suburbs.

Indeed, mental health does not discriminate geographically.

RDNS works with a diverse range of people. Many have chronic and complex health needs. To get the best health outcomes for people we must address both their physical and mental health.

This role entails: • working with RDNS clients and their families to enable them to access mental health assessment, advice and follow up; • working with RDNS staff to help them identify mental health issues and provide advice on how to engage and work with people with mental health issues to improve their health and wellbeing; • translating psychiatric concepts into practical usable language, and anmf.org.au

• liaising with other services to

ensure we are all working together to improve a person’s health and wellbeing.

TO GET THE BEST HEALTH OUTCOMES FOR PEOPLE WE MUST ADDRESS BOTH THEIR PHYSICAL AND MENTAL HEALTH

A typical day involves doubling with nurses to see clients whom they have identified as having potential mental health problems that are impacting on their lives. The day will involve discussing strategies to improve their health and wellbeing and liaising with other service providers such as GPs, public mental health services and community health services so that we

are all working together.

Then there are the phone calls and emails from nurses who may have queries about the mental health issues of their clients. Some of the day may also be given over to working on strategies for nurses to assist them to work effectively with our clients.

The benefits to our clients have been that: • they can easily access mental health assessment and advice at home; • they have nurses visiting who are knowledgeable about mental health, and • we have been able to help a significant number of clients to keep their mental health stable.

As for our staff, they have someone available to provide advice around mental health issues and who understands what they do and how to best assist them to work with those clients who have mental health issues.

Barbara Williams is a Mental Health Clinical Nurse Consultant with RDNS

June 2016 Volume 23, No. 11 43

It’s not too late to start a Graduate Certificate course. Enrol now for our July semester.

ACN’s courses are very competitively priced. Our postgraduate courses are designed by nurse educators, have a strong clinical focus and include subjects that help to prepare you for leadership positions in your chosen specialty.

Postgraduate qualifications can help you accelerate your career advancement. ACN has a range of graduate certificate courses that commence on 11 July 2016.

Choose from the following specialties: • Acute Care • Aged Care Nursing • Breast Cancer • Cancer • Child and Family Health • Critical Care (specialties include Emergency, Cardiac and Intensive Care Nursing)

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Advancing nurse leadership

To enrol: Phone Customer Service on 1800 265 534 or email customerservices@ acn.edu.au For more information www.acn.edu.au

Australian College of Nursing

www.acn.edu.au/postgraduate

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Entry is open to individual PCU Platinum Advantage Members only. The total value of all 22 prizes is $25,025. The full terms and conditions of the lottery including details on how to enter and a full prize listing are available online at www.policecu.com.au/platinum or at any PCU branch. All prize winners will be drawn in a single draw at 11am on Wednesday 27 July 2016 (ACST) at 17 Carrington Street Adelaide SA 5000 and winners will be notified by phone and email or letter by 1 August 2016 and a list of winners will be published in The Australian newspaper on 10 August 2016. SA Lottery Licence No T16/472.

Part 2 MENTAL HEALTH

MASTERING MENTAL HEALTH NURSING

By Louise Ward and Sinead Barry Mental health nursing is a rewarding career that offers significant employment opportunities within the public and private health service. Positions exist within the community, inpatient setting, court system, forensic care, non-government sector, nursing management and private credentialed practice.

Mental health nursing however remains a specialty area of care that undergraduate nursing students express the greatest apprehension and concern about and feel least prepared for attending their clinical placement. Based on preconceived ideas about mental health and mental healthcare there is a need to ensure that undergraduate nursing students receive an education that is innovative, flexible and engaging and will motivate students toward mental health nursing as a career choice.

To provide an innovative alternative to the traditional teaching period and recruit nursing students that were either interested in mental health nursing (as a career choice) or nursing students that were unsure about the subject (and wanted to engage in an intensive teaching model) The Master Class was developed. The Master Class was a five day intensive training program designed to introduce students to mental health nursing and prepare them for their clinical placement. The Master Class was held prior to commencement of semester, within the mid-semester university break period. This unconventional anmf.org.au

teaching period delivered intensive mental health content building on the students foundational mental health knowledge acquired within their general nursing subjects, years one and two. Directly following the teaching intensive, students attended their clinical placement.

The Master Class was evaluated using individual interviews with the Master Class students and two focus groups held pre Day one of the intensive teaching week and post the students’ clinical placement. A total of 29 students were recruited to the Master Class program. All 29 students chose to also participate in the evaluation of the Master Class program.

The Master Class evaluative findings identified four explicit themes: 1. An improvement in the students’ knowledge of mental health and wellbeing.

2. An improvement in the students’ understanding of mental health nursing.

3. An improvement in the students’ confidence and workplace readiness.

4. Increased interest in choosing

MENTAL HEALTH NURSING HOWEVER REMAINS A SPECIALTY AREA OF CARE THAT UNDERGRADUATE NURSING STUDENTS EXPRESS THE GREATEST APPREHENSION AND CONCERN ABOUT AND FEEL LEAST PREPARED FOR ATTENDING THEIR CLINICAL PLACEMENT mental health nursing as a career choice.

One Master Class student reported, “Learning in an intensive week block allowed us to get to know each other and trust each other more. It then meant we could have better discussions. Everyone had an experience about mental health to share.”

Another student made the following comment, “I feel more confident going on my placement now. I feel I understand what I can do to help and what mental health nurses do. I am definitely considering mental health nursing as a career.”

The Master Class was identified as a positive experience for all 42 students who participated. Feedback from the clinical preceptors and the health service management team reported the Master Class student demonstrated confidence, an increased knowledge base and an improved work readiness.

Overall, the Master Class provided a positive impact on student learning and supports the recruitment of mental health nurses to the profession.

Dr Louise Ward is Senior Mental Health Lecturer and Ms Sinead Barry is Lecturer in Nursing.

Both are in the School of Nursing and Midwifery at La Trobe University, Melbourne

June 2016 Volume 23, No. 11 45

MENTAL HEALTH Part 2

ELIZABETH N EMMANUEL

CREATIVE ART: A MEANS OF ‘SEEING’ FOR LEARNING Educating students on mental health nursing in the undergraduate program can be challenging as many students cannot ‘see’ or appreciate mental health concerns in patients. The emotional and psychological distress is often not as obvious as physical distress or ailments.

Creative art used in an assessment piece can help pull some important concepts together. In this study, nursing students were asked to imagine spending a day in the life of a patient with a mental health condition and portray this in a poster using creative art. This was complemented by written work addressing pertinent questions about the patient’s and health professionals’ perspective. The art construction allowed students to pause and consider the individual’s narrative and social context.

Engagement and deep examination helped students delve into the chaos, destabilising, crippling, and even frightening experiences mental health patients go through.

In order to determine the level of learning experienced using creative art, the assessments were measured against Biggs (1995) taxonomy of learning. In addition, qualitative surveys of students and tutors were sought. Results showed strong connections and depth between theoretical concepts and application to real life situations, and aspects of mental health nursing. As expected, students expressed strong engagement with their assessment pieces, learnt about themselves and most importantly, about the experiences of people with mental 46 June 2016 Volume 23, No. 11

THE ART CONSTRUCTION ALLOWED STUDENTS TO PAUSE AND CONSIDER THE INDIVIDUAL’S NARRATIVE AND SOCIAL CONTEXT health conditions.

Although creative art was not the focus of the curriculum, the assessment piece created an opportunity to look more deeply at narratives of mental health patients and linking this with key concepts within mental health nursing. As the teacher, it was as though students frolicked with their ideas as they tried to make sense of these; then produced a tapestry of interconnected concepts to tell a personal story, from a mental health patient’s perspective about one day in their life. Following this learning experience, many students felt less anxious about going on clinical placement. Others talked about knowing themselves better regarding their personal prejudices and devaluing of people with mental health conditions. Some mentioned that they would in future pay more attention to observation and communication skills.

The findings add to the body of knowledge seeking for change towards student centred learning and concept based curricula. Such an approach prepares students to be creative and critical thinkers (Pavill, 2011). Using creative art focuses on students and encourages active learning. As discussed in the review

by Reiger et al. (2015), a greater move towards advancing pedagogical practices is needed to prepare student nurses. Embracing the art of nursing through creative art is one way. In this study, students felt better attuned to mental health nursing, less apprehensive about their forthcoming clinical placement, and increased motivation to learn more about this specialty area.

Dr Elizabeth N Emmanuel is Senior Lecturer in the School of Health and Human Sciences at Southern Cross University, Queensland

References Biggs, J. 1995.

Assessing for learning: Some dimensions underlying new approaches to educational assessment.

The Alberta Journal of Educational Research, 41, 1-17.

Pavill, B. 2011. Fostering creativity in nursing students: A blending of nursing and the arts. Holistic Nurse Practitioner, 25, 17-25.

Reiger, K., Chernomas, W., McMillan, D., Morin, F. and Demczuk, L. 2015. The effectiveness and experience of arts-based pedagogy among undergraduate nursing students: a comprehensive systematic review protocol. Database of Systematic Reviews and Implantation Reports.

13(2).

anmf.org.au

Part 2 MENTAL HEALTH

‘PLEASE BELIEVE ME, MY LIFE DEPENDS ON IT’: PHYSICAL HEALTH CONCERNS OF PEOPLE DIAGNOSED WITH MENTAL ILLNESS

By Brenda Happell and Stephanie B Ewart BRENDA HAPPELL

It often comes as a shock to people when they find out that those diagnosed with mental illness die between 10 and 25 years younger than the general public. The next shock comes when discovering suicide accounts for only about 14% of premature death.

HEALTHCARE PROVIDERS’ NONRECOGNITION OF PHYSICAL HEALTH PROBLEMS PRESENTS A CLEAR EXAMPLE OF A SIGNIFICANT AND POTENTIALLY LIFE THREATENING HEALTH INEQUITY

In most cases preventable illnesses such as cardiovascular disease and diabetes are to blame. If we as nurses are to aspire to holistic and non-discriminatory healthcare, this situation simply cannot be tolerated.

Another common assumption is people with mental illness are not motivated to improve their physical health, it is simply not a priority for them. This is an interesting assumption given most of the research has been conducted by, and from the perspective of, health professionals. Synergy, Nursing and Midwifery Research Centre at the University of Canberra and ACT Health, is strongly committed to consumer involvement in all aspects of the research process.

Acknowledging the lack of consumer voice in this important issue, Synergy researchers Brenda Happell (mental health nurse academic), and Stephanie B Ewart (consumer researcher), conducted research to address this gap. Focus groups were held with 31 mental health consumers from and near the ACT. From four focus groups and nearly seven hours of interview, we found that physical health is important to anmf.org.au

consumers, and unfortunately this importance was frequently not shared by health professionals throughout the healthcare system. Participants provided numerous examples of their physical health concerns being dismissed as symptoms of their mental illness. The following quote presents a poignant example of the concerns of many: “I was having breathing problems and she [doctor] got my file and it said I had a mental health history of depression…the doctor told me I was having a panic attack. I needed Ventolin… she just kept telling me, ‘Oh, it’s all right, just breathe, you’re having a panic attack.’ I’m nearly 50, I’ve had two panic attacks in my life and I know what they are and I said, ‘I’m not having one’… it was almost life threatening, I could have dropped to the floor from not being able to breathe.”

Healthcare providers’ non-recognition of physical health problems presents a clear example of a significant and potentially life threatening health inequity. If the nursing profession wishes to continue espousing the philosophy of holistic care, it must provide leadership here. The physical

health needs and concerns of people with mental illness must be taken seriously and nurses can play an important advocacy role. Equally important is the need to listen to the consumer voice rather than relying solely on professional knowledge as the basis for clinical practice and research. Reflecting on the mantra: ‘nothing about us without us’, every nurse can make a difference.

Acknowledgements

Our sincere appreciation to the ACT Mental Health Consumer Network for their support and assistance with this research, and of course to the participants, thank you.

Professor Brenda Happell is Professor of Nursing and Executive Director of Synergy, Nursing and Midwifery Research Centre at the University of Canberra, Faculty of Health and ACT Health Ms Stephanie B Ewart is Research Assistant at Synergy, Nursing and Midwifery Research Centre at the University of Canberra and ACT Health and Independent Consumer Academic and Life Expectancy Advocate (Mental Health) June 2016 Volume 23, No. 11 47

MENTAL HEALTH Part 2

HEALING THROUGH CREATING: ART THERAPY

By Joanne Rowley and Rachel Comisari Discover your Personal and Professional Potential in Canberra with Mental Health, Justice Health, and Alcohol & Drug Services (MHJHADS) Are you a Registered Nurse, Social Worker, Occupational Therapist, Psychologist or Medical Officer? Do you have a specialist range of skills in the areas of Mental Health, Justice Health or Alcohol or Drug Services?

If you have answered yes to the questions above then we want to hear from you as we are recruiting now.

Do you know that Canberra is rated as the Number 1 City in the world to live?

The Canberra community has diverse culture and a population of 379,000 people with all the amenities of a city but without the stress.

Now for a little about us; the ACT Health Division of Mental Health, Justice Health and Alcohol & Drug Services (MHJHADS) delivers a broad range of acute and community services delivered through partnerships with community and other government organisations. There is a major focus on Consumer & Carer participation in all aspects of service planning and delivery. Our innovative Models of Care have been developed utilising a population health framework and are informed through extensive consultation, and designed to embrace best evidence practice to meet National Standards and the principles of Person Centred Care.

The range of specialises services includes programs in the following areas; • Child & Adolescent Mental Health Services (CAMHS) • ACT Wide Services • Adult Mental Health Services • Justice Health Services • Alcohol & Drug Services • Secure Mental Health Services For more information, please go to www.health.act.gov.au and click on: Employment – Current vacancies Jodie Bowden Manager - Service Development Mental Health, Justice Health and Alcohol & Drug Services Phone: 02 6207 6279 Mobile: 0407207800 Email: jodie.bowden@act.gov.au www.health.act.gov.au For more information visit http://www.canberrayourfuture.com.au www.actmentalhealthjobs.com

48 June 2016 Volume 23, No. 11

Most people cringe at the thought of having to draw or paint a picture. “I can’t draw” and, “I will never be able to express myself through art”, are typically how many of us react when first confronted with the challenge.

CREATIVE MIND ORDERING FEELING OF NOT UNDERSTANDING GENERAL EDUCATION CONCEPT USING STRENGH AND INTEGRATION TO PROCESS DECISION TRIGGER

The purpose of this paper is to highlight the experiences of an art therapy group. It will specifically focus on the transformational processes witnessed where mental health clients moved from an initial resistance to an enthusiasm and desire to attend sessions.

Art as a therapy is increasingly being used in therapeutic communications and supplementing talking therapies (Uttley et al. 2015). The formalisation of art therapy in mental illness began to emerge during the middle of the 20th century. Practitioners noticed individuals suffering from a mental illness often expressed themselves in drawings and other artworks which progressed to the use of art as a healing strategy.

The art therapy program setting for this discussion is in a regional coastal town. Weekly art therapy groups were held and the program was open to people with a mental health issue. The group consisted of up to 20 clients, was semi-structured with minimal rules excluding safety considerations and offered lunch and refreshments.

STRENGTH

INTERGRATION

Music was an integral part of the sessions and guitars were available for those who chose to express musically. Clients often moved between the art supplies and the musical instruments, in particular young men.

ART CAN ASSIST CLIENTS, BY OFFERING AN ALTERNATIVE FOCUS. AT TIMES, CLIENTS CAN BECOME ENTANGLED INTO THEIR THOUGHTS AND HAVE A PREOCCUPATION WITH THEIR PROBLEM OR MENTAL STATE. Art therapy is a creative process of making art with an aim to express feelings, realise repressed emotions and develop personal growth.

The unique opportunity that art therapy provides for non-verbal communication to occur, allows clients to express their feelings safely. The medium may assist people to cope better with stress, improve judgement and have healthy relationships. The therapy is considered by some to improve the mental illness recovery process (Caddy et al. 2012).

Art can assist clients, by offering an alternative focus. At times, clients can become entangled into their thoughts and have a preoccupation with their problem or mental state. Clients reported the art therapy sessions provided a purpose in their day and helped keep their mind occupied on something. We believe it is in breaking the cycle of boredom, lack of purpose and/or motivation that unlocks client’s ability and talents and supports them to explore and reflect on their mental health issues.

There is no single outcome for each client however we have witnessed the client benefits of participating in art therapy sessions. Benefits have included clients joining art galleries, entering their creations into art competitions, displaying their art, selling their art work, gifting their art, discussing their art or in some instances busking in the local mall. Art therapy can activate the courage to dare to try new processes.

The complexity of art therapy is known to be an integral part of the healing process, curing disease is one element and healing the client is another.

The combination of art and treatment is signalling a new era in client care.

Dr Joanne Rowley, CNC Research, PhD Nursing Rachel Comisari, Visual Noise Project

DECISION

ARTWORK COURTESTY R COMISORI 2014

References Caddy, L., Crawford, F. and Page, A. C. 2012.

Painting a path to wellness: correlations between participating in a creative activity group and improved measured mental health outcome.

Journal of Psychiatric and Mental Health Nursing, 19, 327:333.

Malchiodi, C. (2007).

The art therapy sourcebook (2nd ed.)

New York: McGraw-Hill.

Uttley, L., Stevenson, M., Scope, A., Rawdin, A. and Sutton, A. 2015.

The clinical and cost effectiveness of group art therapy for people with non-psychotic mental health disorders: a systematic review and cost-effectiveness analysis. BMC Psychiatry, 15(151), 1:13.

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Part 2 MENTAL HEALTH

INTEGRATED CARE IS TEACHING THE SAFEWARDS EVERY NURSE’S BUSINESS MODEL IN A BACHELOR OF

By Kim Ryan NURSING PROGRAM There is a well-documented but complex relationship between chronic disease and mental health. This interplay can pose challenges for nurses in terms of treatment, and requires the integration of care between multiple sections of the health sector.

At a recent symposium nurses, diabetes educators and other stakeholders investigated the role of integrated care in the management of chronic disease and mental health.

A partnership between the Australian College of Mental Health Nurses (ACMHN), the Australian Primary Healthcare Nurses Association (APNA) and the Australian Diabetes Educators Association (ADEA), the symposium was convened to discuss the challenges and opportunities created by the overlap between chronic disease and mental illness.

Speaking at the symposium, Professor Dawn Freshwater posed difficult questions about the nature of integrated care “Is integrated care something we truly understand, are we able to measure it?” Provocatively, she asked “Is integrated care even possible?” (Freshwater, 2016).

The answers to Professor Freshwater’s questions may never be definitively resolved, however a key message emerged in response to the symposium theme ‘integrated care is every nurse’s business’, communication is key. More than one speaker highlighted communication as vital to integration. A number of speakers focussed particularly on the importance of talking to consumers about more than their immediate treatment needs.

Associate Professor Raymond Chan, discussing cancer survivorship care, told the story of Ken, a 65 year old cancer patient, who was more concerned about his life living with cancer, his finances and social support, than he was about his medical treatment. Ray noted “it’s not about what we think is important, it’s about what they think is important” and outlined the steps he took to assist Ken, including goal setting (Chan, 2016).

Nurse Practitioner Lesley Salem reminded delegates that nurses often focus on asking questions or giving consumers bad news, a one-sided relay of medical information rather than having a shared conversation. Lesley passionately described the way Indigenous people ‘trade’ information in a discussion, urged us to ‘trade’ with consumers in this manner, and asked us to recognise that often people “don’t remember the words you use, but how you made them feel” (Salem, 2016).

Integrating care for a consumer between siloed health professionals can be difficult. Communicating with the consumer, understanding them as an integrated person with a range of needs and then working with them to link siloed services together - that is integrated care.

Adjunct Associate Professor Kim Ryan is CEO of the Australian College of Mental Health Nurses References Australian College of Mental Health Nurses, Chronic Disease & Mental Health Symposium, 2016, Leading through collaboration: Improving self-management through practitioner to practitioner relationships, Freshwater, D. Sydney, Australian College of Mental Health Nurses Australian College of Mental Health Nurses, Chronic Disease & Mental Health Symposium, 2016, Beyond completion of cancer treatment: integrated cancer

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By Leonie Cox, Christina Campbell and Joanna Dalton In the authors’ experience teaching foundations of mental health nursing, undergraduates consistently raise conflict and aggression as a major source of anxiety in contemplating clinical placement. Such worries are perhaps fuelled by a history of negative reports about Australian mental health services (Australian government, 2015) and also, we would argue, by the erosion of mental health nursing as a speciality.

AS RELATIONSHIPS BETWEEN CONSUMERS AND STAFF IMPROVE, THERE ARE FEWER ASSAULTS AND INJURIES AND LESS CONTAINMENT AND COERCION Further as Goulter, Gardner and Kavanagh (2015) show ‘…the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers’.

These changes in mental health nursing practice, present an opportunity to reinvigorate mental health nursing in our undergraduate degree. The Safewards Model developed by Professor Len Bowers and colleagues at the UK Institute of Psychiatry in 2013, aims to make mental health wards safer for everyone and has an impressive uptake internationally including Australia (Keast, 2015). It is based on 10 key interventions and draws on research that identified six domains that were sources of conflict in mental health settings (Bowers et al. 2014). Its implementation is creating safer and more peaceful wards. As relationships between consumers and staff improve, there are fewer assaults and injuries and less containment and coercion. See www.safewards.net/ These outcomes recommend the model as a means to address students’ concerns. We plan to incorporate the 10 interventions in our mental health nursing curricula. In assessments students will demonstrate how their care plans are in line with two to three of the Safewards Interventions. We believe this approach is an innovative means to impart positive principles and tools as a basis for sound nursing practice.

Dr Leonie Cox and Dr Christina Campbell are Senior Lecturers in the School of Nursing, Faculty of Health at the Queensland University of Technology Mrs Joanna Dalton is Nurse Educator at Metro North Hospital and Health Service, Royal Brisbane & Women’s Hospital References Australian Government: National Mental Health Commission 2015. National Review of Mental Health Programmes and Services. Accessed 29 January 2016 www.mentalhealthcommis sion.gov.au/mediacentre/news/national-review-of-mental-health-programmes-and-services-report-released.aspx Goulter, N., Gardner, G., & Kavanagh, D. J. 2015. What keeps nurses busy in the mental health setting?

Journal of Psychiatric and Mental Health Nursing, 22(6), pp. 449-456.

Keast, K. 2015. Safewards shines spotlight on good nursing care. Health Times. Accessed 29 January 2016 http://healthtimes.com.au/hub/mental-health/37/research/kk1/safewards-shines-spotlight-on-goodnursing-care/903/ Bowers, L., Alexander, J., Bilgin, H., Botha, M., Dack, C., James, K., Jarrett, M., Jeffery, D., Nijman, H., Owiti, J. A., Papadopoulos, C., Ross, J., Wright, S. and Stewart, D. 2014. Safewards: the empirical basis of the model and a critical appraisal. J Psychiatr Ment Health Nurs. 2014 May; 21(4): 354–364.

June 2016 Volume 23, No. 11 49

MENTAL HEALTH Part 2

ADOLESCENT MOTHERS’ USE OF SOCIAL NETWORKING SITES CREATING POSITIVE MENTAL HEALTH OUTCOMES

By Samantha Nolan, Joyce Hendricks and Amanda Towell Adolescent motherhood is linked to significantly higher rates of depression and anxiety disorders than for older mothers, with these mental illnesses often manifesting themselves, or continuing to be present long after the actual birth (Coelho et al. 2013; McCracken and Loveless, 2014; Boden et al. 2008).

A recent West Australian study suggests that adolescent mothers’ use of social networking sites (SNS) may improve aspects of their mental health related to parenting stress, anxiety and confidence, while increasing their overall social capital (Nolan et al. 2015). Narrative methods were employed to listen to the voices of adolescent mothers regarding their uses and values of SNS. Themes relating to ‘increased feelings of social connectedness’, ‘improved confidence’, ‘reduced levels of stress’ and ‘enhanced self-disclosure’ were identified. These social capital related themes suggest that midwives could possibly enhance mental health outcomes for this group of mothers simply by promoting careful use of SNS. Most of the adolescent mothers interviewed reported their SNS use to be ‘on and off all day’. The ability to vent feelings and frustrations ‘in the moment’ via SNS was one of the most valued means of reducing parenting stress. Advice, reassurances and ‘likes’ received via SNS were reported to improve confidence both with parenting and in terms of their general sense of self-worth.

Some mothers felt increasingly able to disclose their feelings and

anxieties openly and honestly via SNS than they would during face-toface conversations which may also affect their overall mental health.

Peer support from other mothers was one of the most valued forms of support identified, however many of the mothers interviewed were also keen for midwives and/or other health professionals to engage in the SNS environment to provide accurate health information, links to community events, and to offer professionally validated peer groups.

Midwives were also interviewed as part of the study and proved enthusiastic about the opportunities presented to both promote and /or enhance the benefits afforded by SNS use to this high-risk group of mothers.

They identified safe guideline formation and legal implications as essential considerations for professional practice. Ideas generated from this study included ‘young parent portals’ or specific ‘apps’ designed to promote; local health clinics and parenting events, incorporate; ‘FAQ’ pages and youth friendly health information, provide links to contact designated healthcare professionals via SNS and most importantly, to encourage engagement in online peer support

OUM’s innovative teaching style is fantastic and exciting.

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groups with or without moderated access.

Such interventions could potentially improve adolescent mothers’ mental health using a medium which has become their daily ‘norm’. For some mothers, SNS use was considered ‘a lifeline’ in terms of their coping strategies and mental wellbeing.

Midwives may need to promote, if not enhance this ‘lifeline’ in any ways considered possible if they are to move forward in the ever present and changing world of social media and health. Midwives and Child Health Nurses (CHN’s) are in a prime position to ensure that young mothers appreciate the mental health improvement opportunities that can be afforded by SNS use, and to advocate ways to improve their online safety within the SNS environment.

Samantha Nolan RM, PhD Candidate – University of Canberra Dr Joyce Hendricks, Associate Professor in Nursing, Faculty of Health, School of Nursing and Midwifery, University of Canberra Dr Amanda Towell RN, PostDoctoral Research Fellow, Edith Cowan University

References Boden JM, Fergusson DM and John Horwood L. (2008) Early motherhood and subsequent life outcomes. Journal of Child Psychology and Psychiatry 49: 151-160.

Coelho FMC, Pinheiro RT, Silva RA, et al.

(2013) Major depressive disorder during teenage pregnancy: Sociodemographic, obstetric and psychosocial correlates. Revista Brasileira de Psiquiatria 35: 51-56.

McCracken KA and Loveless M. (2014) Teen pregnancy: an update. Current Opinion in Obstetrics and Gynecology 26: 355-359.

Nolan S, Hendricks J and Towell A. (2015) Social networking sites (SNS); exploring their uses and associated value for adolescent mothers in Western Australia in terms of social support provision and building social capital. Midwifery 31: 912-919.

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Part 2 MENTAL HEALTH

PSYCHOTROPIC MEDICATIONS – STAND ALONE, QUICK FIX OR ESSENTIAL COMPLEMENT?

References Abbott, N. J. 2002 Astrocyte-endothelial interactions and blood-brain barrier permeability. J Anat.

Jun; 200(6):629-38.

By Mick Hawkins Medications penetrate the blood brain barrier in order to be effective, but in doing so, there is the potential for damage to that barrier (Elmorsy et al. 2014).

“The blood-brain barrier is formed by brain endothelial cells lining the cerebral microvasculature, and is an important mechanism for protecting the brain from fluctuations in plasma composition, and from circulating agents such as neurotransmitters and xenobiotics capable of disturbing neural function” (Abbott, 2002).

Given that any medications could potentially damage this barrier gives credence to the argument that pharmaceutical interventions are justified only when less invasive methods of therapy are not applicable and if used, they need to be administered in as low a dose and for as short a time as possible.

There are other reasons for being prudent in the decision to treat with medication. For example, the use of psychotropic medications can cause gastrointestinal disturbances and poor absorption of essential nutrients which in turn can lead to imbalance in gut bacteria and uncontrolled inflammation (Faulkner and Cohn, 2012).

Psychotropic medication’s effect on the gut can reduce any therapeutic benefit because imbalance of gut bacteria and poorly controlled inflammation is often a precursor to mental illness (Mental Health Foundation, 2014; Prescott, 2015).

A large proportion of patients presenting with psychiatric symptoms are known to have had physical pathology that triggered these symptoms (Diamond, 2002).

Additionally, the use of any medication carries with it the risk of death and serious adverse health outcomes (JAMA, 2007).

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But those in the acute phase of a mental illness will often need the quick fix of medications to keep themselves and others safe.

There are also times when only a pharmacological intervention will allow them to achieve a state of mind where they are able to consider and benefit from other interventions.

Even organisations generally opposed to medical intervention concede that “medications play a key role in treatment” (Behavioral Health Evolution, 2016) and that medication can be useful to support the psychotherapy process (Good Therapy, 2015).

Although the evidence is mounting for physiological imbalance as a precursor to mental illness (Brogan, 2014; Meyer, 2015), we still do not know the cause. There is good evidence that, once mental illness symptoms are present, introducing ‘foreign substances’ between the blood brain barrier and constraining the activity of neuro transmitters more often than not helps control these symptoms.

So where does this leave us?

Perhaps an approach that regards medication as the complementary therapy that subdues symptoms while adopting as a major therapy of cognitive measures, that have proved effective in the past, might be the answer. Of course the argument against this could be that we have no direct physiological evidence that cognitive techniques change any bodily activity either, and, in any case, they require more people and more time than our busy health system can provide.

Another approach could be to accept what we do now with our current level of knowledge, but target young and future generations in a primary health initiative in tackling known predisposes to non-communicable diseases including mental illness (Prescott, 2015).

In conjunction with this, more research into the organic causes of mental illness to identify more precise diagnoses so that a proper balance can be achieved between those parts of the body that benefit from the medication against those parts that are damaged and the long term consequences of this damage, could be beneficial.

This paper is not an argument against the use of psychotropic medication.

Even with the horrendous effects of early radiation and chemotherapy for the treatment of cancer, we accepted that these effects were preferable to the illness, and the patient could make properly informed consent.

Recent research has led not only to an appreciation of alternative therapies, but also to much improved diagnosis and treatment of cancer (Keith et al. 2012). It seems reasonable to expect no less in our approach to the management of mental illness.

Mick Hawkins is a Mental Health Nurse from South Australia

Elmorsy, E., Elzalabany, L. M., Elsheikha, H. M. and Smith, P. A. 2014.

Adverse effects of antipsychoti cs on microvascular endothelial cells of the human bloodbrain barrier. Brain Res. Oct;1583:255-68.

Faulkner, G. and Cohn, T. A. 2006 Pharmacologic and nonpharmacologic strategies for weight gain and metabolic disturbances in patients treated with antipsychotic medications. Can J Psychiatry;51:502–11. www.mentalhealth. org.uk (Mental Health Foundation), 2014 Prescott, S. 2015. Origins: Early-life solutions to the modern health crisis.

UWA Publishing Diamond, R. J. 2002 Psychiatric presentations of medical illness: An introduction for non-medical mental health professionals.

Article. University of Wisconsin Department of Psychiatry Herold, K. E. and Rasooly, A. ed. 2012 Biosensors and molecular technologies for cancer diagnostics.

CRC Press Moore, T. J., Cohen, M. R., and Furberg, C. D. 2007 Serious adverse drug events reported to the Food and Drug Administration, 19982005. Arch Intern Med. 167(16):1752-1759 Behavioral Health Evolution website. www.bhevolution.org Hazelden Publishing Accessed 2016 GoodTherapy website. www.goodtherapy.org/ Accessed 25 November 2015 Brogan, K. 2014.

Psychoneuroimmun ology – How inflammation affects your mental health.

Mercola.com Setiawan,E., Wilson, A. A., Mizrahi, R., Rusjan, P. M., Miler, L., Rajkowska, G., Suridjan, I., Kennedy, J. L., Rekkas, P. V., Houle, S., Meyer, J. H. 2015 Role of translocator protein density, a marker of neuroinflammation, in the brain during major depressive episodes.

JAMA Psychiatry 72(3):268-275.

June 2016 Volume 23, No. 11 51

RESEARCH OPPORTUNITY Are you a registered nurse caring for a person with intellectual disability?

CQUniversity Australia is seeking 10-15 registered nurses working in either public and private hospitals willing to share their experiences of caring for a person with Intellectual Disability (ID).

ID is a chronic health condition that has no cure, often necessitating frequent use of hospital services and requiring longer hospital stays.

People with ID are a diverse group with varying intellectual impairments and functional limitations, reflecting a complexity of needs.

In the acute care environment behavioural problems and communication difficulties can be exacerbated for a number of reasons and can pose a challenge in providing quality health care.

SUBSCRIBE TO ANMJ

For further information please contact Virginia Howie by email: v.howie@cqu.edu.au

V O LU M E 2 3 , N O. 2 / A U G U S T 2 0 1 5

STAND

BY ME

Nurses and midwives putting a stop to domestic violence

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Owing to the expansion of our service, various permanent, part time and casual positions are required.

Opportunities exist for suitably qualified and AHRPA registered nurses and enrolled nurses with a minimum of 12 months perioperative experience within the roles of scrub, scout, anaesthetic assistance or recovery room nursing.

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Online applications accepted only https://calvary.mercury.com.au/ Position number 10602 Enquiries Contact: Deborah Roeloffze, Perioperative Coordinator 03 6278 5417

CALENDAR

JUNE Lung Health Promotion Centre at The Alfred 3 June – Theory and Practice of NonInvasive Ventilation (Bi-Level and CPAP Management) 20 June – Asthma Management Update 23-24 June – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au 15th National Immunisation Conference 7–9 June 2016, Brisbane Convention and Exhibition Centre. https://phaa.eventsair.com/ QuickEventWebsitePortal/15th-nationalimmunisation-conference/15nicwebsite Primary Health Care Research Conference Reform and innovation in PHC policy and practice 8–9 June, National Convention Centre, Canberra. www.phcris.org.au/ conference/2016/ International Dementia Conference 16-17 June, Sydney NSW. www. dementiaconference.com/ Renal Society of Australasia Annual Conference From evidence to excellence: New heights in renal care 20-22 June, Sea World on the Gold Coast Conference Centre. www.renalsociety.org/ 13th Global Conference on Ageing 21-23 June, Brisbane Convention & Exhibition Centre, Queensland. www.ifa2016.org.au ANMF Vic Branch Annual Delegates Conference & Health and Safety Rep Conference 23-24 June, Melbourne Convention and Exhibition Centre. This two day conference focuses on exploring occupational health and safety issues for nurses and midwives as well as giving Job Reps the opportunity to vote on resolutions and help shape the direction of the branch for the next 12 months. www.anmfvic.asn.au/eventsand-conferences 18th International Conference on Nursing Informatics and Technology 23-24 June, London UK. www.waset. org/conference/2016/06/london/ICNIT

NETWORK Royal Women’s Hospital, ‘theatre staff’, 1980-1990 reunion Contact Leesa Samarin for further information.

E: samarinl@optusnet.com.au Alfred Hospital, Group 281, 35-year reunion 4 June. Contact E: carolineandrew1011@gmail.com or search Facebook for Alfred Hospital Group 281 Reunion Royal Adelaide Hospital, Group 764, 40-year reunion 18 June. Private room at pub with small charge to cover cost of food platters.

Contact Patrice O’Loughlin M: 0405 399 171 E: patrice_oloughlin@mail.com

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13th International Congress in Nursing Informatics eHealth for all: Every level collaboration – From project to realisation 25-29 June, Geneva Switzerland. http://ni2016.org/ 9th World Congress on Active Ageing 28 June-1 July, Melbourne Convention & Exhibition Centre. http://wcaa2016. com.au/ Active Ageing Conference Wellness, reablement and restorative care in aged care 30 June, Swissotel Sydney. The Active Ageing Conference is a one-day conference and series of workshops to share the latest evidence on wellness, reablement and restorative care, and to equip community care providers with strategies to meet their new requirements. www. activeageingconference.com.au

JULY Aboriginal Health Conference The youth of today, the elders of tomorrow 2–3 July, Pan Pacific Perth. www.ruralhealthwest.com.au/ NAIDOC week 3 to 10 July. www.naidoc.org.au/ Lung Health Promotion Centre at The Alfred 13-15 July/17-18 August – Respiratory Course (Modules A & B) 13-15 July – Respiratory Course (Module A) 20-22 July - Asthma Educator’s Course 28-29 July – Smoking Cessation Course P: (03) 9076 2382 E: lunghealth@alfred.org.au Nurses for Nurses Network Beautiful Bali Member’s Retreat 8-15 July, Kori Resort Ubud, Bali. This is a fantastic opportunity for personal growth and relaxation in a gorgeous destination while obtaining continuing professional development hours for your AHPRA Evidence Portfolio. www. nursesfornurses.com.au/events/147/ Beautiful-Bali 21st International AIDS Conference 17-22 July, Durban, South Africa. www.aids2016.org/

4th Asia-Pacific Global Summit & Expo on Healthcare 18-20 July, Brisbane, Qld. http:// healthcare.global-summit.com/asiapacific/ Health Informatics Society of Australia 24th HIC Conference Digital health innovation for consumers, clinicians, connectivity, community 25-27 July, Melbourne Convention and Exhibition Centre. www.hisa.org.au/hic/ ANMF Vic Branch - Mental Health Forum: Advocacy 29 July, Carson Conference Centre, Melbourne. www.anmfvic.asn.au/eventsand-conferences DonateLife Week 31 July-7 August. www.donatelife.gov.au/

AUGUST International Academy of Nursing Editors Conference 1-3 August, London UK. http:// inane2016.com/ Lung Health Promotion Centre at The Alfred 4-5 August – Influencing Behaviour Change – a formula 17-18 August – Respiratory Course (Module B) 18-19 August - Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au International Day of the World’s Indigenous People 9 August The Australian and New Zealand Cystic Fibrosis Nurses Conference Preparing for the future 11-12 August, at the Hotel Grand Chancellor, Launceston. The theme reflects the changes in management of Cystic Fibrosis and aim to empower Cystic Fibrosis nurses to continue to improve care and plan for the future for patients, families and other health professionals. http://www.cysticfibrosis. org.au/all/nurses_conference

ANMF Vic Branch - Working Hours, Shifts and Fatigue Conference 18 August, Carson Conference Centre, Melbourne. Find out how working hours, shifts and fatigue affect the health and safety of nurses, midwives and patients in this exciting one-day conference. Get practical strategies for reducing the impact of shiftwork and fatigue. Aimed at all levels of nursing and midwifery, this conference will be particularly useful if you roster or manage staff. www.anmfvic.asn.au/ events-and-conferences

SEPTEMBER Australasia-Pacific Post-Polio Conference Conference Polio: Life stage matters 20–22 September. Four Seasons Hotel, Sydney. This conference will facilitate better care and build international connections by bringing together health care providers, researchers, polio survivors, their caregivers and patient organisation representatives. www.postpolioconference.org.au

OCTOBER Lung Health Promotion Centre at The Alfred 6-7 October – Managing COPD 24-25 October – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au Childbirth and Parenting Educators of Australia National Conference Nurture the primal instinct 12-14 October 2016, ‘the Sanctuary’ Adelaide Zoo. Registration Open. www.ivvy.com/event/capea Australian Disease Management Association 12th Annual National Conference Person centred healthcare: Achievements & challenges 20-21 October, Melbourne Convention Centre (MCEC). www.adma.org.au/ E: info@adma.org.au T: (03) 9076 4125

Hyperbaric Technicians and Nurses Association 24th Annual Scientific Meeting 10-14 August, Hamilton Island, Queensland. http://htna.com.au/ moodle/

Royal Adelaide Hospital, Group 765 reunion Suggest combining with 764 at The Gov (Hindmarsh) 18 June. Contact Christine Freeman (nee Williams) E: christine_ freeman25@hotmail.com

Woden Valley Hospital, L Group, 35-year reunion 1-3 October. Contact Murray Harper M: 0448 211 059 E: dodgerlily21@bigpond. com or search Facebook page “Woden Valley Hospital L Group”

St Vincent’s Hospital, Melbourne, August 1986, 30-year reunion 5 August. Contact Celia Kenny (nee Murphy) E: paulandcelia@hotmail.com or search Facebook page AUGUST 86 30YR REUNION 2016

Princess Alexandra Hospital, Group 59C 30-year reunion 7-8 October. Contact Jenny Whittle (nee Dredge) E: jennydredge@hotmail. com or search Facebook page 59C Princess Alexandra Hospital Group

Ballarat University, Diploma of Applied Science 1986-1988, 30-year reunion 18 September, George Hotel, 27 Lydiard Street North Ballarat from 2pm onwards. Contact Paul Smith M: 0410 561 421 E: pcsmithrn@hotmail.com

Royal Melbourne Hospital, October 1976, 40-year reunion 8 October, Naughtons Parkville Hotel.

Contact mezzarankin@gmail.com or Kris Alderson (nee McGuigan) E: pjka@ ozemail.com.au or Jane Beetham (nee Collyer) E: beethams@mmnet.com.au

RAH, group 772, 40-year reunion February 2017. Interested? Contact Bronwyn Glitheroe (nee Deed), AnneMarie McBride (nee Rogers), Helen Kirby (née Osborn) or Rhona Edwards (nee McGarrigle) E: rah772reunion@gmail. com or search Facebook page Rah772

Email cathy@anmf.org.au if you would like to place a reunion notice

June 2016 Volume 23, No. 11 53

MAIL FEATUR E

FEATURE

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hospital’s regularly nurse executive dissects , which and work nursing force patt numbers broader erns on level. a One of strategie St Vincent’s new s Older Pers involves its Care est of the Program, on Graduate Nursing pathway a specialised aged care that offer FEATURE option s an alter to grad uates who native on the hosp miss out program. ital’s mainstrea m acute “We’ve we’ve got noticed a nich way,” Ms graduates com e and ing in that gets themRiddington expl ains them care into St Vincent’s . “It the track er opportunitie . It gives . Whether s down care is they stay complet in aged ely up want peo ple to stay to them. We a typical full stop big REA NUMBER of opportu hospital, ther . Like Finding S FOR RATI SED their grad nities when theye’s lots SOME ACT OS. Accordingsolutions UALLY LEFT to ANM NURSING diversity uate year to play finish Federal of healthca AND in the Secretar F Assistant creative y Ms Ridd re.”

ALTOGET MIDWIFERY thinking, Annie Butler, future grad ington’s core of inno the deve UNDERTO HER AND advice vativ uates cent OK FUR to getting collabora e models, and lopment res EDU expo THER around CATION tion, unde sure national robust, ways to IN ANO rline the diverse, to as much solving THER FIELD. primary and enga clinical The ANM the problem. plac ging INCALC THIS IS THE F continue think ther ement as poss ULA potential ible. “I s to spru AND SYST BLE HUMAN the univ e’s a responsibility ik HECS feesstrategies like EMS COS ersities waiving that have to student OF NOT employm for graduate ensure has lots HAVING T s who acce ent in area the cons of A opp such as PRO pt olida s of high ortunity PER PLAN rural and to need, skills and te because it’s and esta . remote thousands of new the clini blishing health; Australia by 2025, resulting bottleneck cal patients communicating Beth Moh between solid predicted to hit that matt The with le large metr partnerships able to ers. They e of 109,000 nurses to find employment each year. the and rural do Despite a shortag ive transition into hospitals, opolitan that well anything if they ’ll be relations and midwives struggletaking away their right to support ates the complex .”

115 grad can do hips betw and similar graduate nurses and uates each primary Fedele investig next generation funding health netween hospitals year, rece their future, Robert Opening is locking out the from the and orks.

Ms Butl iving graduates ponder governm Victorian Professo doors ent for encourag er says evidence workforce. As many facing the profession. r Maxine the first graduate ing of Scho chan dilemma 10 Duke, Hea s with som ge is eme ol of and critical there on. and a percenta e rging, at Deakin Nursing and Mid d of the first time to follow ge from impleme hospitals, for left home for the Universit wifery example, nting spec “We inter move quickly clinical came up short. for grad viewed placeme y, agrees that her dream. But the areas. Again she took 115, uates unab ific casual poo 500 and land is all a public nts way to she soon returned ” formal ls le to secu essica Westmore we An interview with future emp can pave the turned sour and Director says Deanne plac to re a appeared Riddingt of loyment. them conn ement in a bid trained up with nowhereschool to Adelaide. hospital in Sydney Educatio the hospital’s on, partThe university to ected in high contract but in another main Nursing n Cen nerships the prof keep go. After finishing St Vinc “It was a full-time promising but ended “We inter tre. with seve tains formal ession. they only gave in nursing, organisa to ‘excessive Melbourn ent’s Hospital n healthca view once I got over there knock back due she pursued a career r degree at tions want to in re meet thema lot because they said for the making e is one such “We try across Victoria. me 16 hours and applicants’. undertaking a three-yeaAustralia, we inten hosp inroa and .

It’s very sive ital clinical work with be a carer and South labour The hosp ds. part first two years I’d the University of them. We but we want to g in ital app students ners and have our I was like ‘Well mee oints abou the last year an RN. and eventually graduatin keep goin name on don’t want them t the placeme what you told me t a piece g to thos Nationa nts hang on that’s not March, 2015. of paper.” to be a “I e Ms Ridd d their cour for a great here”, she says. l Data ington deal of Regrettably, the 21-year-ol ed when I came over on the sits on with the se so that they pay my rent or eat Labour to a disillusion the ’re organisa couldn’t afford to currently belongs Market I organisa tion and familiar graduates unable stayed there until I for so nursing of much Reg tion pretty the cohort a istered is familiar back home at the been a year and Nursing Nurses with them could and just got to find work. “It’s Graduate – 2007 ,” applying for jobs (2015). I’ve been to 2014 s (4 mon start of the year half that I’ve been ths afte kitchenhand, Percenta r graduatio 2007 working as a cleaner, full on. ge emp for nursing 2008 n) since.” loyed full “I will keep applying 2009 and waitress ever time g going 2010 Percenta 2011 jobs but I am considerin ge emp 2012 loyed part Walking away into another field.

2013 I wanted 2014 time or not uncommon andPerc 97.4 As much as it’s what Jessica’s story is casual entage that 96.7 start the & problem. from seek unemploy 96 ing full supports a rising to do, if I knew JESSICA THEN by time ed 93 to happen I LAST YEAR ALONE, 92 Latest figures released (GCA), SOURCE: GRADUATE 1.8 this is what was going CAREERS 92 2.3 bothered.”

Australia AUSTRA ESTIMATES SHE APPLIED 83 2.5 Graduate Careers wouldn’t have even LIA (GCA) Jessica 300 80.5 ANNUA annual survey 20 5 L AUSTRA FOR MORE THAN Like many students, which conducts an 5.6 February 0.8 LIAN GRADU of graduates 2016 Volum ATE SURVE a job as a nurse 6 1 NURSING JOBS. Y examining the fate thought landing 12 e 23, No. 1.2 97.4% rward given the the completion of 14.2 7 2 four months after would be straightfo 2.5 steady a workforce reveal 2.5 their qualifications, outlook of a looming 5 past decade in the horizon.

5.3 Last year alone, Jessica decline over the shortage on the mood has for more graduates who But these days her number of nursing estimates she applied just want jobs. as she continues jobs. “I manage to find full-time nation’s than 300 nursing swung to disbelief IN 2007, 97.4% OF the a permanent job. to be in theatre THE NATION’S In 2007, 97.4% of something. I want to struggle to find anmf.org. d I’m not degree found full-time au NURSING As the end of her nursing graduates eventually but I understan away. g.

2014 Jessica straight GRADUATES months after graduatin d going to get that approached in late care, I work four FOUND ally applying for the figure plummete I work up from aged 2014 by But Whether began methodic as FULL-TIME ts. She applied want to start off to just 80.5%. don’t care. I just graduate placemen WORK FOUR Chantelle, SA Health, Queensland resident a nurse.” for a position within MONTHS AFTER at Griffith year, Jessica a spot at one of In November last who studied nursing hoping to snare GRADUATING but was in r graduate hospitals, graduated three-yea a and public University was offered the state’s claims just half care facility in applied anywhere December last year, position at an aged unsuccessful. She her bags she including 17 Melbourne. Packing and everywhere, 23, No. 7 February 2016 Volume rural and remote interstate and in

NEXT

GENERATION

HELPING GRADUAT

E NURSES AND MIDW

IVES FIND JOBS

J

GRADUATE ST VINCENT’S HOSPITAL BUREK GOODING, TORI NURSES L-R TAZ TABONE. AND NATASHA CHRIS HOPKINS PHOTOGRAPHY:

FINDING GRADS JOBS I write in response to the ANMJ Feb 2016 article, Generation next- helping graduate nurses and midwives find jobs.

It was during my role as clinical teacher that I learned the difficulty and hardship third year nursing students go through in order to obtain a prestigious graduate year program, and was often approached for assistance with job search preparation. I’d like to point out some of the issues that were not discussed in the article.

Firstly there are minimal graduate year program positions at the acute tertiary hospitals, making them extremely competitive as these positions are only given to Australian graduates. I believe this is unfair particularly because there are many international nurses coming through universities such as La Trobe, Deakin, ACU and Monash who have paid full fees to study as a nurse in Australia.

The Victorian government could support more graduate positions similar to what the Queensland state government did last

NURSING IS A MAGICAL PROFESSION After three years of planning, I have finally taken the step to become a Registered Nurse. This year marks the first year of my university training, and I can honestly say it’s one of the best things I’ve ever done.

54 June 2016 Volume 23, No. 11

FEATUR E

Professo r Duke says. “So comes to when it likely to choosing stud shortage ents choose of ones they they’re experienc improved places for grad e of.” have since the uates has Deakin global finan easing Tori appl across thre University ope of the cial crisis ied for rates She said . hund jobs but about 700 e campuses kept gett reds of nurs all key stake it is now incu and ing ing rejec mbe each year nursing students takes in “It was holders TORI BUREK to prom . to work nt on constantl six months’ longted.

PHOTOGRA ote care together According y going ers acro service PHY: of CHRIS home, HOPKINS in places ss the to figur to work of the univ es, heal about 87% th and aged such as men health a bit and applying for , coming find jobs ersity’s nursing tedio tal jobs debunk care in graduate after com come to us after a while . It gets order to tradition degree, s pleti a ng rega al perceptio ranking rding even wort point where youand you the scho their the natio graduate the need to com ns h it?” think is ol among n’s lead it ers. year in plete Duri Professo ng a an acut r Duk kept conn the state of limb e setting. are thor Don’t give oughly e says students training ected by unde o, Tori drilled on the trans up rtaking courses Despite ition from making ANMF, offered the grad the work agency by persistin uate situa force and university to jobs, and the nursing g, consider encourag jobs. nonSecretary ANMF Assistan tion a range ed to t Federal In a strok of entry “We talk optimist Annie Butler rema opti e of luck to secu ic. other than about opportu ons. , Tori ins re “Stick St Vincent’sa graduate posi was able and acut the metropolitan nities tion at your story it out. Come to e via a mid- Hospital in about ruraltertiary hospitals. area Melbourn circumsta . Let us know whaus. Tell us year intak began of our stud and interstate We talk e. She final e her care out mor nce is so that we t your . er Sept e ways as very easil ents find emp Some a nurse ly ember, to try and can find she says loyment y last orthopae starting off . help,” Professo in Perth and so on the dics r Duk forth,” In the “It soun ward.

“The majo e explains. short-sig same vein, while ds clich do think rity [of stud htedness feel they the everythin éd but I really and lack ents] still should reason of fund of governments be in an setting because g happens for ing may to blam to acute a in learned e right historical consolidate but to work that six months fundame for the crisis, ther ly be , cultural that’ hard myse sa I ntal area acute is e’s one er and lf up, overlook now as artefact. Subperhaps to pick about nurs and everythin ed in the acute used be and still ofte g I learn job: dilig acute is ing battle to n to in ed me now that time ence intensive these days find a as care Registere and luck. . that time well. So I don will help d nurse “And ’t regret .” testamen Tori Bure t opportu aged care has Reflecting k is pays. Tori to the adage incredible nitie on her message persisten a very shor s for nurses. experienc journey, to of ce With isola grad ed Tori’ in the similar tion ANNUAL through t time they’ll uncertain uates confront s hand after and soul-sea feeling mov the GRADUAT ing persever ty is simp rching firstmanagem ranks to doin e completi ES ing. le: deg FROM g keep ng a nurs case ree at Victo TASMANIA much quic ent or leading She says ing ria Univ Albans teams she feels ersity’s work at campus TODAY, acute envi ker than they hum St St in Octo ALMOST Her failu would in ronment.”

HALF OF forward Vincent’s and bled to ber, re an Professo is looking to a long position to secure a grad 2014.

THE STAT r Duke thing I left her believes love the career. “The wonderin flattened uate 300 ANN E’S the most is I’m work g where and anmf.org.

UAL the ing wrong.

GRADUA au every day at. If you com place Over the she had gone TES STRU e next six GGL passiona with people who to work months, TO SECU E te as you are as RE the who are then A GRADUA le diffe it makes rence.”

TE POS

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anmf.org.au

year introducing its $111 million plan.

International students, who struggle particularly on clinical placement with communication skills, often fail based on their inability to build therapeutic relationships with patients.

How did the student get onto the course in the first place? The government needs to address the issue of high intake in numbers of nursing students. At what point should this be capped?

The IELTs or OET is the next hurdle for international students once they have completed their degree however this is a very difficult exam to pass and sometimes takes several attempts over years.

The problem this leads to is Div 1 (RNs) and Div 2 (ENs) nurses working in roles that are inappropriate for their skill set such as aged care. This has a knock on effect whereby the graduate nurse eventually deskills, having minimal acute care exposure and loses confidence in applying for acute roles that would be more appropriate in the future.

Graduate nurses who end up in aged care are good in their roles and sometimes get promoted quickly (as per Professor Maxine Duke) but this poses problems on the aged care system whereby nurses lack acute

Nursing is a magical profession; it holds so much joy, so much versatility and wonder.

I have spoken to many people, some of whom are nurses and they have all said to me that it’s the best career to get into, as you never know what’s around the corner, as well as being wonderfully rewarding.

I have found this to be true already, not even having completed my first semester at university. Every time I put on my uniform and walk through the doors into the clinical room to practice, I feel such a sense of pride and happiness; a feeling of

care assessment skills and are unable to recognise an acutely unwell resident, assess their condition and manage symptoms effectively. Graduate nurses should not start their careers in aged care. They should be consolidating knowledge and skills in an acute setting, but there are not enough graduate year program positions.

I would recommend all students work hard to achieve particular goals on placement, sometimes the student will get recognised and poached.

Apply for nurse bank or nurse pool positions as these usually lead to permanent positions. Also use LinkedIn to network with organisations. Please contact me if you need assistance in the job finding process kelly@nursingcareermentor.com Kelly Toft RN, Vic Editor’s Note: The ANMF has committed to safeguarding the employment of graduate nurses for the past five years.

The priority has been in ensuring domestic graduates get jobs and are properly supported in all areas including aged care and primary healthcare. To date programs in these specialities have been proven very successful for grads in regards to support and the consolidation of skills.

‘yes, this is where I’m meant to be.’

It is truly an honour to be heading into a career which is held so high in people’s esteem, and to be able to make a difference in people’s lives.

Nurses are superheroes, and I am deeply honoured to be a part of this world.

Julia Backhouse SRN, Tasmania

anmf.org.au

MAIL FEATURE LOUISE DEARMA

N, PHOTO:

GRANT NOWELL

FEATURE

TAKING ENROLLED INTO A NENWURSING ERA

L

As a new team takes the foundation s of enrolled helm to champion the enrolled to strengthen nursing education and practice nursing workforce, the future major chang in of enrolled es nurses - our Australia. Together, these devel are reshaping the nation’s ‘esse opme ntial nurse s’, writes Karennts are working Keast.

ouise Dearm an at North Easter is an enrolled nurse n Health develop their Adelaide, scope of practic where a nurse-Centre in established e. led about 10 years clinic was “A lot of enrolle ago.

Louise is passio knowledgeab d nurses are so nate about nursing, so amazing, and le and their skill sets much so that enrolled are up her hand is very differe every nurses’ scope she recent ly put of practice to become of enrolled the that they’re nt in accordance to the role nurses as Presid national face doing and National Enrolle the preparation ent of the that they’ve education Australia (NENA d Nurse Association she says. had for that of role,” ).

enrolled nurses are a vital workforce at a time when part of the health increasing the sector challenges. faces

“As we go forward into need to have the a workforce future, we together,” she says. “In that works well seen that registe general, we have red nurses While enrolle “You can’t nurses do and enrolle just d nurses are work well d healthcare together, they one box and box all enrolled nurses very compl system’s ‘essen renowned as our ementary say ‘an enrolle work in a in the partner with and collab enrolled nurse’ tial nurses d nurse is orative way. registered ’, who an you’ve more direct nurses to delive history, their got to look “In acute care patient care, at their knowledge but then also often conced and their scope enrolled nursesr base, the contin working across uum, as people e of practice.” their skill base differe stigma attach there’s an unwarranted move throug nt parts ed to the role. h Enrolled nursi opportunitie of the health system , there’s s for enrolle “The minute Enrolled nurses ng it is challen d you annou ging at times nurses but I think have transfo enrolled nurse nce you’re landscape have a full rmed the an of appreciation for everybody to you are stigma go - ‘you’re the second nursing care provision nurses can of what enrolle tised. People just level practit contribute. since d says. “I actuall an enrolled nurse’ introduced ioner role ,” was first in just an enrolle y still hear myself say Louise ‘nursing aides’Australia under the “We’re meant title of in 1950, and to be using so much from d nurse’ because you ‘I’m with ‘enroll within our all the worke later replac ed nurses’ hear health ed rs you just start so many different places it in 1981. going to need care system and we are that “Then you to refer to yourself as Over the years, it’s important them in the future, walk that. so I think that we look the enrolle just an enrolle away and think - ‘no, workforce enrolle d at nursing people like d nurses has flouris I’m not hed. member of d nurse, I am a well Midwifery nurse to have , who are a good flexible educated the nursing Board of AustraThe Nursing and in the workfo fraternity’.”

September lia’s rce.”

(NMBA 2015 quarte Louise says almost 60,000 rly statistics ) Louise, who while many show began her enrolled nurses registered experienced registered country hospit career workin are now nurses apprec to g in als before as a skilled iate enrolle extra 5,043 practice in Australia, 15 years in spending and d nurses while an are concur general practic the last nursing workfo knowledgable part rent / registered nurses provid e, of the nurse or dual enrolled nurse rce, she finds e more hands- says enrolled emanates registered enrolled nurse the stigma on care. from some midwife. / corners of profession.

“It’s all about the nursing It giving that professionals also stems from other Enrolled nursing patient - facilita direct health and the wider practice has ting their care, care to the in the past advocate, community. also evolve being their decade. A and those d It’s a stigma growin are all the enrolled nurses about being things Louise wants an enrolled , and all new g number of Enrolled nurses now educat to stamp out. nurse,” she I love graduates, ed to admin should says. are merit, she be judged enrolled nurses ister medic says. on their ines. While “As an enrolled nurse, are require the superv you connection ision of registe d to work under with the patien have a closer “Enrolled nurses can actually get nurses are also suppo red nurses, enrolled to spend the t because you a valuable of the nursing rt and superv workers and patient.” time with the member ise students in fraternity, educated some contex other and who can who are well ts. go on and Commonwea Major chan ges Officer Adjunclth Chief Nurse and Behind the Midwi scenes, severa t Professor are redeve Debra Thoms fery l pivotal initiati loping the anmf.org.au says ves backbone nurse educa of enrolle tion and practic e in Austra d lia.

March 2016

Volume 23,

No. 8

21

WE ARE REGISTERED NURSES AND EXPERIENCED Recently I read the articles and letters ANMJ featured about Enrolled Nurses. In my mid-twenties and an EN for almost seven years, I love nursing and am every bit as passionate about the role importance of ENs in the nursing workforce.

Formerly, I worked for 12 months as an in-charge nurse for a 100-bed aged care facility. It involved significant responsibility and I’m grateful for the experience I gained. Currently I am back into an acute role in a Gippsland public hospital medical ward.

When I qualified in 2009, I was registered with the title Registered Nurse Division 2 and all documentation had RND2 behind my signature. Just a little while into my nursing career, the Nurses Board took a major backward and discrediting step from Registered Nurse Division 2 to calling us Enrolled Nurses. Now we sound like students enrolled in a course but not qualified and registered. RNs and ENs are REGISTERED with the same nursing board.

We actually are registered nurses and accountable.

Can someone enlighten me as to what we are enrolled in? I to this day do not understand. It is discrediting, degrading, and discriminatory that the Board does not acknowledge us as registered when in fact we pay our registration fee every year, maintain our professional development requirements, hold professional indemnity insurance, not to mention a professional qualification. At work I tend to turn my lanyard backward so my title is less visible. If patients see Enrolled Nurse, they can assume I am not qualified and therefore not trust my competence and experience.

Who decides that nurses who hold a Diploma of Nursing are less registered than those who hold a Bachelor of Nursing? We are both qualified professionally with accredited training and registered with the same Board.

Registered Nurses hold a higher qualification but that does not make ‘socalled’ Enrolled Nurses any less registered. So why call one registered and one enrolled when both are registered. The differentiation should be in the level or division of nursing that is held. Not that one is registered and another merely enrolled – and enrolled in what?

/ APRIL 2016 V O LU M E 2 3 , N O. 9

FEATUR E

LETTER OF THE MONTH

HOW AUS

TRALIA’S

ASYLUM

SEEKER

POLICY

IS DAMA

GING CH

ILDREN

Australia’s continues asylum seeke r policy growing to polarise opini as a Child unrest confi on, with and Youth has come rming the charity Recre Save the time the natio to definitively Children, ation Officer with almost a year on decid Saman n She pinpo trying to Nauru during tha spent moral obligconsiders its ethic e what inted inadeq improve 2013/14 lack of privac al and and adult the daily uate housin nurses and ations. Unwa y, the welfar veringly, children g when I gotfemales. “It was lives of childre health e and healthand being overlo n believe a very rude of sexua conditions there,” she recalls the gove professionals care of shock l and physic oked, freque rnment’s policy of . “The living to prope nt report just unacc are just absolu al abuse current indefinite r legal repres s tely , a lack being referre causing trying to eptable. We were abhorrent. of access entation It’s immeasura detention is give the d to by and reside actually kids a bit basically just identificatio harm and ble and nts play of an outlet n numb must end. SEEKER irreparabl “It is our developmen and have a ers. speaksS ASYLUM to moral obliga bit of e of Robert to to minim HOW AUSTRALIA’ the camp. t and get away psychosocial ise the suffer tion to these reforming the key campaigneFedele from the ” endured people CHILDRENrs trauma the deba as the produ ing they have POLICY IS DAMAGING policy te.

I

alread Samantha ct of ,” Saman tha wrote our immigrationy “We now Nauru hardstill finds the memo t has been in ries from their lives have the oppor her submission. sticks out to erase. One a human described as tunity to for the scene which surrounds nothing warehouse. ask for better, camp the more women, their and we change and unforg A place where than were and its subsequentflooding of the can committed forgiveness so utterly of the crimesonly shuffled men, evacuation. against out until hopeless ivably, children, children them in imagine water subsid Staff feel that they years to we’ve and familie they On reflect fact we come.” unbearable would be better sometimes were cleare s were left behined, but was imper ion, Samantha off dead. kids and by difficu living condit says speak ative. “I The parents d out to safety d. “The lt but nothin ions make somet think ing out hitting in weren’t and the of sexua getting hing remai g rivals was terms of l assault, says purpo like this is being ning silent on and seen how they just really hard reported self-harm, the episodes as the sand sefully. We can complicit,” she be kept in not being impor were treated wait, somet commonplace. and abuse and just dig our safe.” tant enoug kids don’t head in hope it freedom imes for years, People sit and h to goes have that fades. This as the Since Nauru option.” away but the reality, of is the harsh, prospect of , Saman Samantha an active unmasked Australia’slife in detention tha has voice agains become at ventured admits the conte governmen centres. offshore immig one of t the into black ntious issue ration proce lot of advoc Last year, t’s treatment Australian and has ssing of ates, includ white territo not for appeared she made a submiasylum seekers. ry. “A For comm ing mysel open borde before ssion to unity servic f, we’re let’s let Recent a Senat Betts, deten and everyone rs. We don’t es worke Allega e say yes, a check tion was in. There r and Circum tions relatin Inquiry into and an eye-o Samantha does g balanc to stances have to be proce pener. Worki Proce at the RegioConditions be ssed. Howee and people ng submissing Centre anmf.o need to standards nal ver, the rg.au ssion allege in Nauru. Saman internationa for deten on processing d nume l of tion rous shortctha’s we’re going are 71 days asylum seeke omings. rs for an over that for years. by detain adult and It’s ridicul ing people ous.”

www.anmf.org.au

16-21_A

NMJ April16_

Asylum

Seekers

.indd 17

April 2016

Volume

ANMJ GETS BETTER AND BETTER

23, No.

9

17

22/03/20

16 5:02 pm

Nowadays there is uncertainty all around us but one thing is certain: each new issue of the ANMJ is better and more informative than the previous. What a feast for the mind the April 2016 issue was.

I devoured it from cover to cover as soon as I laid my hands on it. Not only was it packed with current and contemporary issues, it facilitated the deliverance of person centred care in an ever changing and dynamic work environment.

Information sharing leads to empowerment and this is evident on several levels: management of diabetes, facebook etiquette, the feature on asylum seekers and of course, the article on Jenny Lumsden. Wow! What a fantastic role model and what joy it was to read about her achievements.

I am so proud to be a nurse, and proud of the fact that this official magazine inspires me each month to be a better nurse. It helps me to think laterally and accept differences more readily, while at the same time educating me. Congratulations and ‘well done’ to all contributors and editing staff for presenting us with this extraordinary issue. Believe me, the April 2016 issue will be a ‘go to’ issue for quite some time!

Manisha Sheorey RN, Vic

The winner of the ANMJ best letter competition receives a $50 Coles Myer voucher. If you would like to submit a letter to the ANMJ email anmj@anmf.org.au Letters may be edited for clarity and space.

No, I am NOT just an Enrolled Nurse. I am a registered nurse who holds a Diploma of Nursing with a recognised scope of practice and competencies.

I am qualified, competent, experienced, and registered. I am not enrolled in training as the title Enrolled Nurse would suggest.

Rachel EN, VIC Editor’s note: Div1 and Div2 were the titles given to Enrolled and Registered Nurses in Victoria only. Div 2 nurses have always been known as Enrolled Nurses in all other states. In these states the title Enrolled Nurse is widely recognised by all nurses to represent their qualifications and competence in the full capacity of their position.

anmf.org.au

June 2016 Volume 23, No. 11 55

ANNIE

IF YOU DON’T CARE, WE CAN’T CARE The night before writing this column, I was in Sydney attending a NSW Nurses and Midwives’ Association (NSWNMA, the NSW Branch of the ANMF) meeting of delegates to discuss the upcoming federal election and the ANMF’s campaign, If you don’t care, we can’t care.

Annie Butler, Assistant Federal Secretary

Just before I spoke to the delegates, the NSWNMA showed them a campaign video from Bernie Sanders, one of the democrat candidates for the President of the United States, which was extraordinary. It outlined the principles, which underpin Bernie Sanders’s campaign focus of addressing the almost unfathomable inequalities that exist in the US, those of morality and justice.

The video was inspirational. And as I got up to speak to delegates, apart from thinking, ‘wow, how am I supposed to follow this?’, I wondered what it would be like to have a political candidate with such vision, such compassion and, underpinning it all, such morality.

Australian principle of a fair day’s pay for a fair day’s work is under threat.

The appalling lack of regard Australian governments and politicians show to our elderly by ignoring them, by silencing them and by taking away the funding that would allow them some dignity at the end of their lives, means Australians’ very decency as human beings is under threat.

What kind of a society condones removing funding from the most frail elderly, in some cases up to $50 a day, to pay for tax cuts for businesses and those on higher incomes?

Not one I believe that most nurses

WITH 250,000 ANMF MEMBERS AROUND THE COUNTRY, NURSES AND MIDWIVES CAN AND MUST MAKE A DIFFERENCE.

A STILL FROM THE ANMF CAMPAIIGN IF YOU DON’T CARE, WE CAN’T CARE

Just two weeks before the NSW meeting, I had been in Parliament House in Canberra to hear, for the third consecutive year, the political leaders of this country announce a Federal Budget with significant cuts in funding for vital health and aged care services in the midst of funding boosts for businesses and those on higher incomes.

Of course we are not yet the United States of America, we are still Australia. But as far as I can tell, the Australia I know, and the Australia most nurses and midwives want to keep is under threat.

The systematic erosion of Medicare and the refusal to fund public hospitals properly means that Australians’ right to universally decent healthcare is under threat.

ICareandIVote

The erosion of workers’ rights and a persistent and systematic attack on penalty rates means that the

56 June 2016 Volume 23, No. 11

and midwives want to be part of. I believe nurses and midwives want to be part of a society like the one that Bernie Sanders is fighting for, a moral and compassionate society.

But we will have to fight for it too.

NSWNMA members had just suffered a significant loss, with the NSW government rejecting the recommendation from a recent state Parliament Inquiry into nursing homes to ensure an RN is on site at all times.

The NSW government effectively washed their hands of ensuring quality care for the elderly in their state by claiming it’s not their responsibility, it’s a matter for the Commonwealth.

Having run a significant campaign to defend quality care for aged care residents, RN 24/7, NSWNMA members were understandably deflated by the government’s response. But as I spoke to them, I explained that we’re not done yet, in

fact I believe we’ve just begun. This is why the ANMF’s federal election campaign is now so important.

NSW members will now be joined by another 190,000 nurses and midwives from across the country in the fight for aged care, in the fight for health funding and in the fight to save Medicare and to defend penalty rates.

The ANMF’s national federal election campaign will see nurses and midwives in all states and territories challenge the government, the Opposition and the Greens to commit to action on our four key issues: • Restoring $57 billion in health

funding over 10 years;

• Removing the rebate freeze

on Medicare and protecting bulk billing; • Protecting penalty rates for all workers, and • Ensuring safe staffing in aged-care facilities, including a registered nurse on site at all times.

Because without these commitments nurses and midwives hands are tied, we will not be able to deliver the expert level of care we know our patients need.

Nurses and midwives’ issues are critical to the sort of society we want Australia to be so it’s up to us to make them critical issues in this election.

We need to bring health and aged care to the forefront of the election campaign to make sure voters understand how important these issues are and to challenge politicians to commit on issues that matter to all Australians. Because if they don’t care, we can’t care. We need to make them show they care.

To do that we all need to be involved and do everything we can. With 250,000 ANMF members around the country, nurses and midwives can and must make a difference, and we need to bring the community with us. We need to ask them to show they care and to help us make politicians care about the most important issues for a decent Australian society.

Because as Bernie Sanders said in his extraordinary video, when hundreds of thousands of people stand up and fight they win.

For more information about the campaign go to: www.icareandivote.com.au/ anmf.org.au

We do everything as if you are here You work hard caring for others; we work hard to care for you.

Your needs, your goals, your future.

You wouldn’t have it any other way. Neither would we.

Winner.

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